Pharmacy. Jim Plagakis. Pharmacist

My Dear Independents.

There will be enough business for you in the “baby-boomer” decades ahead.  You gotta change your paradigm or the goose will be screwed. 

You will never, ever make AWP + $3.75 on PBM claims.   That was what PCS and PAID Prescriptions paid in

1966.  It will never be that way again.

Your paradigm absolutely must be that you get paid for pharmacy services.

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This will NEVER happen with the current model.  NEVER!

The first, best step is to give up being the hero of an Ayn Rand novel.  Practicing Rand’s religion “Objectivism”  is not possible for an independent pharmacist in the 21^st Century.

Your best bet is to take the pittance that you will get for each Rx and pay your techs.  Maybe even the light bill. 

Gear up for making your living by providing pharmacy services.  

There is cash money to be made.   Clients will pay you for your expertise.

Counseling, MTM and immunizations will make money.  You can make a living, just as the doctor, ARNP or PA will make a living by using your knowledge.

I believe that SINGLE PAYER will be the model that will reward you.  If the PBMs and the insurance companies are allowed in the picture, they will just continue bullying you. 

Go ahead..Scream at me, “It is SOCIALIZED MEDICINE.”  So frikkin what?

Can’t you see that the PBMs have you by the balls and they have been increasing the squeeze for the last two decades?  So, just get them out of the picture.  All the insurance companies do is move money.  They take in $100.00 in premiums and shell out $80.00. 

That $20.00 provides NO medical care whatsoever.

A single payer administered by the Feds will give you fees for service.  The Feds are used to doing this.  Do your homework.  Don’t mention Canada to me.  The Canadians spend a little over $3,000.00 per person per year for medical care.

We spend close to $8,000.00 per person.

I do not care what you thought when you bought the store.  Most of you are not scions of  industry.  You are just making it.  Single payer puts service on top.  The end of Wal-Mart.  Single payer will make you a professional again.

Here is what Barack said when he was still a State Senator.  Call him.  Ask him why he changed his mind?  Is the insurance lobby that powerful?

STATE SEN. BARACK OBAMA: I happen to be a proponent of single-payer universal healthcare coverage. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent—14 percent—of its gross national product on healthcare, cannot provide basic health insurance to everybody. And that’s what Jim’s talking about when he says everybody in, nobody out: a single-payer healthcare plan, universal healthcare plan.  The “Jim” Obama is referring to is Jim McDermott, a legislator from Washington State who is well known for advocating for the citizens of the USA.

Take a look at the new page entitled “MEDICAL-Industrial Complex.

Consider this while you are damning Walgreens to the dungeon where all evil and divisive employers end up.  ENRON FIELD.

The baby boomers are those people born between 1946 & 1964. 

The first of that group just turned 62 in 2008.  There are about 20 years to go and IT IS CUMULATIVE.

In 1997, there was a boomer turning 50 every 7 seconds.  4,000,000 will turn 50 in 2009

In 2009, the boomers are those Americans between 45 & 63 years old.  The BOOMERS are still relatively young.

The pharmacy industry is close to breaking already and look what is coming. 

Here is a 1996 figure. 76,000,000 between the ages of 32 and 50.  If they are still alive,

that was 29% of the population in 2006.

The older you get, the more prescriptions you will need if we continue the medical model of treating sicknesses rather than preventing them.   Remember.  The number of boomers is CUMULATIVE.

The BOOMERS are still relatively young.  Wait a few years and you will see the pay off for POWER. These people (The Boomers) will not “age gracefully” as their parents did.  Why should they?  They eat better, they exercise, they meditate and they have the wonders of pharmaceuticals.

What they want is to stay vibrant, energetic, youthful and sexy for the entire ride.  That ride will be longer and longer.  That means an impossible to forecast number of prescriptions.

This is a “No Brainer”.  Walgreens and CVS and Rite-Aid (if there is one) cannot build enough stores because there is not going to be the professionals to staff them.

Walgreens is prescient.  They see what is coming and they want a piece of it.  They are not sitting on their hands,

The problem for me is the mean way they are handling their employees.  There has to be a better way to transition.  If they hurt too many people, a very angry gorilla may swallow them up by choosing to practice pharmacy elsewhere in the future.

Drug Topics magazine “scooped” the pharmacy magazine industry and reported on Walgreens’ POWER before anyone else had a clue.  Drug Topics is THE news magazine for our industry.  I am not going to explain POWER to you.  Go to the Drug Topics home page and put “Walgreens POWER” in the search spot.

Since the Drug Topics report, there has been a ton of talk on the blogosphere and via lightning e-mails about POWER.  Many of the writers are “crepe-hangers”.  They see the end of pharmacy as we know it.  They see technicians doing all of the dispensing and I say, “Why not?”  There are better things for pharmacists to do.  Like “Patient Care”.

They see pharmacists out of jobs and the ones who are still working being chained forever as slaves in the galley.  Sweaty, starving, exhausted and dangerous.

I do not join the “doomsayers”.  They have been predicting disaster for decades. 

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I testified at a meeting of the California State Board in 1972 or around there.  The big question was:  Does California allow technicians,  recognized by the state, to work in the pharmacy.

Omigod, it was the end.   The Retail Clerks International Association (union) brought in three lawyers from New York. 

The CPhA screamed about pharmacists put out of work.  Silent Venom divx

 Well, my friends, you know how that turned out.   Without technicians, we would be doomed.   My testimony was in favor licensing technicians.  My eye is good.  Trust me.

POWER is a brilliant opportunity to free up pharmacist time at the “Prescription Mill” to actually do professional patient care duties.  Like- Counseling.  Like saving lives.  I’d give you odds on a bet that patients have died due to lack of counseling.

With pharmacists having the time to counsel, I say that NOW is when the 50 State Boards of Pharmacy give up the farce that is the make-believe enforcement of counseling laws.  If the pharmacist has time and does not counsel, then it is on her and her employer.  They both must be cited.  They both must be fined.  Both licenses must be suspended for seven days.  Let the pharmacist cool her heals watching Ellen and the pharmacy be closed for seven days.  How is that?

Washington State has been a bellwether for decades.  The technicians in Washington had been licensed for years on that day in California.  Washington will be the first to start nailing pharmacists whose noses are so stuck to the prescription mill that they don’t even look up.  After Washington sets the standard, all of the dominos will fall… with certain southern states holding on until they have no choice.

The Pharmacy Boards are mandated to protect the public from you and me and what we do.  They haven’t listened when we told them that “A TIRED PHARMACIST IS A DANGEROUS PHARMACIST”. 

It is imperative that we start making demands NOW.  For how to get to your state board.  Go to this blogspot.  This guy has links to all 50 boards in the right hand column.

http://www.pharmacistdaily.blogspot.com

You are professionals.  Start acting like it.

There are some incisive comments on the page titled “Walgreens POWER”  To put them all at the same spot, I’m going to copy and paste them on the comments here.  JP

I think that some of the readers of what I write have a faulty picture of old “Jay Pee”.  I usually write about my successful transactions with my patients/customers.  On occasion, I’ll tell you about the trouncings I take.  There are people who just are not charmed by Jay Pee’s efforts.

I am a risk-taker.  I take chances with people.  It usually works out.  One of the things I do is touch.  In the puritanical US of A, we don’t touch enough.  Touching gives a comforting message.  Go to southern Europe and you get kissed and touched more in one day than in a year in Vermont.

Two decades ago, I got creamed.  My eidetic memory can even recall her fragrance.  It was Diorissimo.  I remember the Lily of the Valley.  A good-looking, but plain brunet asked my help in the feminine hygiene area.  While I was stressing to her that regular douching will kill the bacillus, the good bacteria, I lightly touched her forearm.

She went ape-shit.  I apologized and quickly retreated.  I was told by a good customer who had observed the scene that this attractive brunet was an ex-Roman Catholic nun who had put up with regular sexual abuse from a priest.  I’m still going to touch.  Especially when I am reassuring a patient about her illness.

The Friday before Mothers Day, I was assured that I still have it.  I can’t see it when I look in the mirror, but a customer made my day. Transporter 3 buy

I always make eye contact.  I always smile if that is appropriate and I will always frown if that is what the transaction requires.

Last Friday, I made eye contact with this guy and we laughed about something.  I touched his forearm and gave it a squeeze.  Then he invited me to go deep sea fishing with him over the weekend.  We would go way out in the Gulf of Mexico, spend the night on his boat, fish a little and come back on Sunday.

This guy is as gay as Elton John.  He is always color coordinated.  He gives girly-girl body messages better than any woman can.  He is 5 years younger than me.

I told him that I had to prepare for Mothers Day.

“Oh….You are lucky that your mother is still alive.”  He batted his eyes and moved his shoulders in a manner that no man could replicate.

“My wife,” I said.

“Oh No, I didn’t know.  You are…”

“…I am straight,” I said, “But, man, thank you for the compliment.  I am honored that you would find me to be attractive.

“Oh…yes.  If ever……”

I have a joke that makes most customers laugh.  When the copay is really low, like $1.20.  I step back in mock horror and announce.  “You are robbing us.”  Everybody has fun laughing.  Almost everyone. A grouch bucket just said, “Shut up about my copay.”

Late last night, I filled a trazodone Rx for a 67 year old woman.  I had her spotted as a woman distressed.  Her blonde hair was stringy and for some inexplicable reason, she had a pencil thin strand rubber banded so it hung over her left eye.  She asked me if the drug is for depression.

When I gave her the Rx, I said, “So.. you are down in the dumps?”  Of course, I made eye contact, but I did not smile.  You don’t smile when she is depressed.

She gave me a blank look.

“That means…you got the blues, the Galveston blues.”

“I do have the blues.  My son doesn’t want me to live with them anymore and the apartment is like solitary confinement.”

Of course, I touched her arm and said, “Well this is a good chance to make new friends.”  That was the wrong thing to say.

“I can bake the best blueberry muffins,” she said, boring me with her eyes.  “They will melt in your mouth.”

“I’ll bet they are delicious.”  Oh oh, I was feeling a little tense.   Please, I thought.  No, please do not invite me to your apartment.

“Do you like Lou Rawls?”

“I do enjoy Lou Rawls.”  I cringed. 

“We can listen to Lou Rawls and I’ll bake the muffins.  I like Cognac.  Do you like Cognac?” 

This was killing me.  She had gone from a face that said death-is-coming-soon to classic I-might-get-laid-tonight  body language.

I took a deep breath and lied to her.  “I feel like I am getting the Swine Flu.” 

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What was I thinking?  “My body aches all over and I just need to go home and get some sleep.”  I immediately regretted it.  Someday I’ll have to tell her the truth, but last night, I did not want to add more weight to her blue mood.

It is all about balance, you guys.  My shtick usually makes me a winner, but there are times when I plummet off the high wire.

Take a chance, you guys.  Relax.  Be yourself.  Connect with these people. 

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When Vladimir Horowitz, the brilliant piano maestro was asked how he could play so perfectly, with no mistakes, he said, “I always make mistakes.  The secret is to blend the mistakes in so no one notices them.

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Balance!  There is an old Japanese proverb:  Even monkeys fall out of trees.

How do you tell a fat woman that she is fat?  How do you tell her that she looks ridiculous wearing the skin-tight fashions that are popular with women who are fit?   How do you tell her that her eating habits are killing her?  How do you tell her that she needs to lose weight?  How do you tell her that it is a matter of life or death?

I will confess that I have a prejudice about fat people.  I tend to see them as participants with some choice in the matter rather than victims.  When they go to Friendly’s (I pick on Friendly’s because of the monstrous portion sizes) and order a giant cheeseburger with a mountain of fries and wash it down with a chocolate milk shake, do they know what they are doing?

Many of the 60% of Americans who are obese just do not know what they are doing.  They were raised on fried foods and they feed fried foods to their children.  They even save bacon fat in the refrigerator to use to make grilled cheese sandwiches.  Much tastier than butter.

You are a pharmacist.  Do you just ignore these people?  Some of you think that they are pitiful.  You cheer when the news comes out that they will have to buy two seats on the airplane.  Have you ever been subjected to the squeeze when an obese person gets the seat beside you?  Is watching from the sidelines appropriate for a medical professional?

Recently, I took 13 prescriptions from a woman who is grossly obese.  From metformin to Plavix and all that is in between.  I gave her the standard south east Texas greeting,   How ya doin’?”

“I ain’t doin’ like shit,” she said with a wheeze.  Two of her Rx were for puffers.  “I might as well die.  My son went to college and I ain’t got nobody at home.”

“Don’t you have friends or relatives?”

“My momma and my papa died already and I don’t talk with my sister.”  She gave me a look.  “I don’t know what to do.” Poseidon on dvd

“You might want to lose some weight,” I said, “You probably wouldn’t even need all of these medicines.”  I was watching her face.  It screwed up and got mean.

She stabbed her finger at me.  The front of her dress was wet.  She had been sweating.  I had to give her credit.  She actually came into the store.  It seems that half of the drive-through patients are obese.  Some come in pajamas. 

“Mind your own goddam business,” she said.

“Has the doctor talked to you about this?”  I was intrepid.  In for a dime, in for a dollar.

“The doctor talks to me every time and I tell him the same thing.” 

“Do you think that losing weight could make you healthier, that you could feel much better?”

“This is for you.”  She lifted her left leg a few inches and blew a big, loud fart.  “Do you think I am stupid?”

“Maam, I just…….”

“Of course I know that my entire life would get better if I lost 100 pounds.  I may be able to get a boyfriend, take a walk around the block.  Man, you think I am stupid.  That is an insult.”

A very thin and fit white woman was observing all of this.  She probably had been running on the seawall.  She wore skin-tight thigh length Under Armour shorts, a Nike sports bra and a thin short sleeve shirt that she left unbuttoned.  She stepped in.

“Baby, the druggist is not insulting you.  (Baby down here is like Honey is other places)  I think he wants to help you.” 

The black woman stared at her.   “Maam, I’m not telling him.  He can listen in.  I’ll tell you.  Food stamps ain’t a picnic at the deli at the Kroger store. 

I don’t eat no chops.  I bought me two nice tomatoes because they were on sale for 97 cents a pound.  Food stamps means macaroni and cheese.  The box kind.  Hamburger Helper.  Kroger brand soda pop, white bread and the cheap cheese.”

Oh oh. I did not want an argument between an affluent white woman who keeps herself in terrific shape and a jumbo-sized black woman.  I chickened out and stepped back and pretended to talk with the technician.

The next thing I know the two of them were sitting in the waiting area.  One fit comfortably in the chair.  The other had to squeeze in.   They sat there until the Rxs were ready.

The fat woman called me over.  “My new friend and I had a nice talk.”  The fit and trim woman was watching with a big smile.  “I’m gonna try, man.  I’m gonna try.”  She chuckled and nodded to her new friend,  “Baby, Brenda lost 60 pounds and she is a weak-ass white woman .”  They both laughed and then they hugged.

That taught me a lesson.  Once again, the pharmacist is the one at the bottom of the funnel.  I think I need to speak up when the fat patient gives me an opening. 

I think I need to expect a big fart for my efforts.  I expect that they will resent it that I am the messenger.  That is okay.  I do not want to be their friend.  I am the pharmacist.

Oblong pills, round pills. It almost always ends up with the patient swallowing a pill.

Excluding surgery, what percentage of office visits end up with a prescription/s being written, often poorly? My guess is 90%. Perhaps more. Tell me your estimate.

I think that the patient walks into the examination room and before the door is closed for that 20 minute wait for the doctor there is a Ka Ching sound and the patient’s pocket book or her insurance gets billed for a couple hundred bucks.

The patient comes to you and you Ka Ching

for $80.00 for each brand name Rx.

At the end of the day, poor Auntie Mildred has put out close to $600.00 for medical services.

What does Auntie do if the diagnosis was faulty and the prescriptions did nothing for her medical complaints? What if the diagnosis was spot on and the drugs did not help? What if both you and the doctor say, “Tough shit, Mildred!”

You don’t take that from the guy who services your Honda Accord. When you go to the dentist, he better get it right. Your 130 pound hong kong massage therapist better get those shoulder muscles relaxed and feeling better.

How about we Tie a drug’s price to how well patients do? Gadzooks, Batman, that will never work. Whoever heard of such a stupid idea? That would be like Big Pharma guaranteeing the efficacy of the drug.

Well, here you go:

“In a deal that was expected to be announced on April 23, 2009, Merck has agreed to peg what the insurer Cigna pays for Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar.” Prime ipod

“Earlier, the makers of Actonel agreed to pay the insurer Health Alliance for the cost of treating fractures suffered by patients taking Actonel.”

Some guy named Dan Hecht (Proctor & Gamble) said, “We’re willing to put our money where our mouth is.”

My question is, “Danny boy, what about the old lady who can’t stand the dosage routine and doesn’t take the Actonel? Her son gets the Rx filled every month and doesn’t know that she throws it away. There is such a phenomenon called non-compliance.”

Danny boy still has to shell out for this poor woman’s fractured hip. Six weeks in a nursing home.

I honestly don’t think this is a bad idea. Pay the big price for good outcomes.

Robert Seidman, who used to work for WellPoint, gushed, “Outcome guarantees for pharmaceuticals is very healthy.”

This is nothing new. This idea took hold years ago in countries with national health systems.

My worry is that how are the PBMs going to get YOU to pay the price for this? They seem to manage to get the pharmacist to pay for way too much.

You are at the bottom of the funnel.

Details from The New York Times

You may have read these pages and think that “Jay Pee” believes that the American Pharmacists Association is a consistently failing institution.  I may have led you to believe that my respect for the APhA is a two on a scale of one to ten.  That is not really how I feel.

The APhA stepped from a safe and secure spot in our profession to one that has loyal members stop writing dues checks about five years after hitting retail.  They changed the name from American PHARMACY Association to American PHARMACISTS Association.

With this name, we cannot be criticized for expecting the APhA to be looking out for the welfare of pharmacists.  You would expect this oldest of the old organizations to have taken strong stances about chain drug store working conditions,  the tyranny of the PBMs, a behind the counter class of drugs, the CVS/Caremark merger and on and on and on.

The problem, my friends, is NOT the APhA.  The problem is our unreasonable and unfulfilled expectations.  My goodness.  Look at the mission of the APhA. 

Improving Medication Use.  Advancing Patient Care.  PERIOD!

And those are very good things to aspire to.  Poseidon rip I sincerely hope that patients live longer and are healthier due to the efforts of the APhA, I hope that the active members of the APhA are happier than pigs in shit over the results that they are getting because there are thousands of pharmacists out there who think that the APhA is a catastrophe when it comes to advocating for pharmacists in those questions that matter the most to pharmacists.

The National Community Pharmacists Association does a much better job looking out for our interests.  The problem with the NCPA is that it is an owners’ organization.  Join if you want, but you have to be an owner or a manager of an independent pharmacy to be allowed to vote.

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THE PHARMACY ALLIANCE to represent you and me in the issues that are vital to keeping pharmacists happy, wide-awake, alert and focused when it comes to advancing patient care. 

Let’s agree that the difference between a pharmaceutical and a poison is just dosage and frequency.  Take enough atenolol often enough and you are dead.

If advancing patient care is one of the two pillars of APhA

, why hasn’t the APhA had a shit fit about tired pharmacists churning out prescriptions six hours after a bag of a salty snack and a Coca-Cola is the only meal of the day?

I would expect the organization that has the names PHARMACISTS, American and Association all strung together would be all over the NABP and the 50 boards individually about just this one disgrace.

The APhA has the name and, when it comes to the health and well-being of the pharmacists with their feet on the floor that is all it has.  The APhA is too important to even acknowledge your petty problems.

I suggest that pharmacists need to give up the hope that the cheating husband is really faithful after all.  He is not.  His head is in the clouds.   He likes the feeling of being important.  He loves it that the entire family looks up to him.  The truth is that Mom divorced his ass twenty years ago and he never did pay child support.

How about giving up PHARMACISTS?  Change the name to American Patient Care through Medication Use Association. 

Please do not be vulgar.  You can criticize the APhA in an adult manner, without stooping to four letter words.  I know that you are an emotional wreck every 13 hour day with no breaks.  I know that your technician caught an error that was potentially the end of your career the other night.  I know that the most dangerous pharmacists are the tired pharmacists.

You cannot use the excuse that you were exhausted.  Sorry.  The really bad news is that there is no large, mainstream organization out there to look out for you.   He left for the No Tell Motel with his secretary thirty years ago.