Thanksgiving Day 1975. Somewhere between Zurich, Switzerland and Nice, France. An Italian opera singer reminded me that it was Thanksgiving. We shared her hard crusted bread and swiss cheese. I had salami, apples and a big bottle of Vin Ordinaire. A memorable Thanksgiving meal

 

Today is the first day that I will wear the bar code on a badge on a chain around my neck.  If I say I counseled, I WILL COUNSEL.  Jay Pee  7-30-2010

Texas Pharmacists

Please Report

The Texas State Board now requires that pharmacists “sign off” that they have counseled on new prescriptions.   TSBP will have plain clothes investigators observing and failure to counsel will result in citations.

How are you handling this?  Are you recording the counseling on the back of the Rx or do you have an electronic method?

I spoke with an employee of CVS last week.  He reported that the pharmacists at the CVS Pharmacy where he works NEVER COUNSEL, but the computer records that the counseling DID take place.  This sounds dangerous to me.

Apparently, at CVS, the timers are more important than being legal.  I believe that counseling will prove to be a valuable professional service and it will be perceived as such by many patients. 

I wear a nametag with a bar code on it around my neck.  When new prescriptions are sold, I scan my bar code with each prescription. 

This signifies that I did, indeed, counsel.  It is recorded that Jim Plagakis counseled.

A patient can refuse counseling and that is recorded the old fashioned way, with paper and pen.

YOU CAN BET YOUR ASS THAT I AM GONNA COUNSEL ON EVERY SINGLE NEW PRESCRIPTION.   I will not lie.  I will not cheat just to satisfy the appetite of the “Prescription Mill”. 

 I am pleased that the company I work for does not have flashing red lights or sirens to goad me into deception.  Those poor bastards at CVS who are expected to do things by the seconds are gonna get their asses in trouble.

This is important for our profession and the pharmacist jobs in Texas.  You can cheat and relegate yourself into a very high-priced technician or you can man up (woman up) and do the right thing.  Counsel like you are supposed to.  Your style is going to evolve.  If you think you can do all of these on every single Rx, you will fail.  You will have to pick and choose the most important points.  A young mother who does not read well will need more counseling than a 30-something RN who works at the Trauma Center.

Name & Strength of Drug

Appearance of Drug

What did your doctor tell you about this drug?

The purpose of the drug

Route of administration

SIG

Side Effects

How to Minimize Side Effects

Storage

Refills

What to expect from taking this drug

Do you have questions?

 

What did I leave out?

 

Be smart.  Very few counseling sessions will require you attending to

all of these points.

 

Open a Word document on your home computer right now.  Record any difficulties you have with counseling.  Most important, if you work in a pharmacy that is run by timers and you are pressured by either the computer or BY A SUPERVISOR to cheat.  Document that incident.  Please do this.  You may be a valued witness at a State Board of Pharmacy hearing one day.   This can be the beginning of taking pharmacy back for pharmacists.

It is time for you “Prescription Mill” slaves to step up.  Ahh,I trust that we will get plenty of comments about how impossible this will be and that there is no time.

 

TOUGH!

 

"I'm the Non-Pharmacist Store Manager, Harold. You Know that You Don't get a Lunch Break."

Two messages from a patient.  I asked if I could record them here and he agreed.

> Hi Jay Pee -
>
> IANAP and I don’t play one on TV. I’m just a pharmacy customer with a number of chronic conditions, although none of those you mentioned.
>
> The time of which you speak has already come for we who are forced to mail order our prescriptions. I had had the luxury of getting 90 day fills for about the same price – and sometimes less – at retail. I had the luxury of being able to fill all of my scripts at the same pharmacy. The staff know me and my history, and tell me the important stuff – what to do, what not to do, and what to watch out for.
>
> I no longer have this luxury since I can’t afford to pay the cash prices for all my scripts. My trusted, knowledgeable allies behind the counter no longer have the whole story, although there are some scripts I fill there because the cash price on some generics are less than the mail order copay.
>
> I would feel more confident getting my scripts through amazon.com than I do getting them from the “not-so-glad-I-met-ya” mail order mill. I have received products made by God Knows Who Pharmaceuticals – no telling if they’re AB rated, because I can’t find out much about a couple of these companies. Are they tainted? Produced with ingredients obtained from dubious sources? There’s no telling, and the only information I get is the same junk any pharmacy’s software spits out along with the label.
>
> Damn it, Jim – I want my pharmacist and my pharmacy back! I want to be able to get all my Rxs from the same place, from people I know and trust, and who will watch out for me.
>
> You pharmacists are undervalued. Letting corporate morons walk all over you (especially the 2 giant Wals) is insane. Your trade association seems as lame as the medicinal chemists’ trade association (see Derek Lowe’s “In the Pipeline” blog). Perhaps if the pissed-off patients joined forces with the pharmacists, maybe we could get some action going.
>
> (Don’t get me started on PBMs, or I may end up on some of those meds you mentioned.)

 This is an “I’m mad as hell and I’m not going to take it anymore” issue for pharmacists and consumers alike. Mail order and central fill are crappy systems that isolate the pharmacist from the patient and physician, when all three need to be able to work together.

Shoot, I know more about certain drug interactions than my PCP, but that qualifies me only to tell her not to give me certain meds – their Epic EMR system isn’t doing that job. My pharmacist clued me in on some of this stuff.

What I fear most is the potential of idiot insurance companies and moronic PBMs getting the not-so-bright idea of outsourcing. This brings up complex issues including data security, timeliness, and usage of potentially tainted pharmaceutical products, to name a few. My current employer’s outsourcer costs them more than they save because all the screw-ups have to be fixed here.

The insurance company is the one represented by Sen. Lieberman (I-Aetna). (Their tag line used to be “Aetna, I’m glad I met ya” hence the pseudonym in the post.)

BTW, my old insurance was my state’s high risk pool plan, and they used a pharmacy company PBM headquartered in the state. Fortunately, I could take scripts to many different pharmacies – I refuse to go to that chain’s filthy, crowded, dank, dreary dungeons.

About the only concrete thing I can think of is to write my senator. Any suggestions you and your colleagues come up with would be much appreciated.

Sorry for rambling – this is a real hot button item for me.

Let’s make this discussion reasoned and based

 

 

 

on more than fear or hope.

There has been a lot of talk right here and other places that we are doomed.   That pharmacists are going to be phased out at worst or marginalized at best by the big Drug Store companies.

 

I do not believe this, but I will listen.  There was screaming in the 1970s that the new laws allowing pharmacy technicians would take pharmacists out of the loop.  You know what happened there. 

 

Now, again, thirty years later, the same gloom and doom fear-mongers are back. 

 

I want to get this started.  I don’t have time today to present my argument completely, but let’s start here.  In 1970, the population of the United States of America was 203,000,000 people.  Today, it is 310,000,000.  Drugs are at the end of the funnel for almost every office visit.  A paradigm of our culture is that THERE IS A DRUG FOR EVERYTHING.   With a 35% increase in patients, there is probably going to be an increase of more than 35% in the number of prescriptions.  My experienced tells me that.  The average patient with a chronic condition takes more prescription medicines than 35% more than their counterpart in 1970.

 

IN 1970, THERE WEREN’T THAT MANY DRUGS TO CHOSE FROM.

 

That’s a start.  I’ll discuss the enormous pressure that the baby boomers will put on the Prescription Mill this weekend.

 C’mon you gloom and doomers, give me your best. 

The Ace in the hand, the trump card is going to be the pharmacist doing what she/he has been trained to do.  Using her knowledge and experience to assist in better outcomes.

I know that you think that you do not have frikkin’ time, so don’t whine to me.  If you gloom and doomers want your down-in-the-dumps forecasts to come true, just keep doing what you have been doing.  Just keep running the “Prescription Mill”, disregard your legal and ethical responsibilities for counseling. 

I see nothing wrong with good technicians doing all of the filling.  I see a lot wrong with pharmacists not even looking over to the patient. There is a lot wrong when the patient is looking at her pill bottle, then at you, then saying, “Excuse me” five times and you still ignore her. 

The best way to be sure that you continue to have a professional’s job with a professional’s wage is TO BE AND ACT LIKE A PROFESSIONAL.

In 1970, a hypertensive 50 something male with hypercholesteremia and high trigklyerides would be given HCTZ, possibly reserpine and may hydralazine.  Ciba made the combo.   Ser-Ap-Es.  There were a lot of strokes in those years.  Resperine was terrific, but it depressed the heck out of the patients.  For the lipds, doctors were recommending margarine (like Parkay) instead of butter. 

Today, that patient will likely get HCTZ, atenolol, amlodipine, pravastatin, gemfibrozil.  Maybe more.  Five prescriptions instead of one.  Plus his Cialis, bupropion, Flomax, Celebrex and allopurinol.  That’s ten drugs a month for one guy and everyone of you knows plenty of men just like him.  He complained about the quality of his orgasms.  They were flat.  You recommended the pravastatin instead of Lipitor and now he has wowees.

Let’s use age 62, the year one can start drawing Social Security for these purposes.

An American turns 62 every 7 seconds.

In 2020, 4,245,000 Americans will turn 62.

Between 1940 and 1994 (the boomer years) 202,000,000 Americans were born.  77% of all Americans now living were born after 1939.

I have a file of statistics, but I want to go and have a swim.

These people will not grow old gracefully.  They will spend a lot of money to be vital, youthful, full-of-it and sexy for entire ride.

There will be money to be made and those among you with a little personality, some vision and just a little daring can take advantage of this opportunity. Talk to me at:  jpgakis@hotmail.com

In the meantime, those among you who just want to be an employee can keep on going.  Just make sure that you are the ones who mold the profession of pharmacy, not Wal-Mart or Rite-Aid.  HEAVEN FORBID.

 

 

 

 

 

 

 

 

Walgreens Wins

 

 

You Win

 

 

Everybody wins when the company that operates on the HIGH ROAD faces down the company that consistently operates on the LOW ROAD.

 

Some of us held a strong opinion that the CVS-Caremark merger violated anti-trust laws.  The G W Bush years.  A lot of strange pro-business things happened in those eight years.

 

The only losers in this huge drama were the PBMs.  If you are an independent owner, you will be emboldened to demand better contracts.   And… you better.

 

CVS can no longer steer people to CVS Pharmacies or to their Mail Order place by promising 90 days and a lower copay when the Medicare Part D patient can get 90 days and the same copay

at any pharmacy.

 

I’ll add to this later. I want to hear what you have to say.

.

Reiterate the Rite-Aid word.

“With the potential removal of Walgreens from the CVS/Caremark network, we have a tremendous opportunity.

The best reason that Walgreens CVS/Caremark insured patients have for transferring their prescriptions to Rite Aid is YOU. You are part of the Rite Aid pharmacy team, a group of caring professionals, who provide outstanding service to our patients every day. Taking care of these new customers will help to win them over and bring them back!”

Both here and at Facebook, pharmacists have stated that Rite-Aid pharmacists will not be able to pull this off.  Because of disinterest, because of work load, because of insufficient technician and cashier help.  Rite-Aid’s track record and share price being less than the price of a 20 oz Doctor Pepper is mentioned.

The comment has been made that CVS pharmacists will not be able to pull this off either.

  They will look at the increase work, the need to call for transfers or to call prescribers for new prescriptions.  CVS pharmacists routinely work long shifts with no regular meal or rest breaks.  Many of them work 3 fourteen hour shifts a work.  They are not interested in working harder.  Period!

        What do you think?  Are they right?

******************************

THERE IS A POSSIBLE SEA CHANGE COMING.  IF THE INDUSTRY DOES NOT TAKE A STAND NOW, IT WILL NEVER HAPPEN AND THE PBMs WILL CONTINUE TO BULLY US. 

CVS-Caremark will fight WAG as hard as they can.  Because, if they make concessions to WAG, no right thinking pharmacy owner or chain middle executive would ever sign another bad contract.

THIS OPPORTUNITY CANNOT PASS.  BRING PRESSURE TO BEAR ANYWHERE YOU CAN. 

We have a chance to right the ship and we have Walgreens to thank.

 

 

 

 

6/13/2010 at 10:08 AM

Rite-Aid’s Stock

is trading at $1.11 a share.

 

Rite-Aid is missing the chance to finally get the PBM’s part of the process rather than the Dictators of the process.  Stupid! Idiots!  Rite-Aid pharmacists and pharmacy staff are the most over-worked of all.  The idea of having to court and win over a whole new group of patients who were very statisfied at WAG has got to depress them.  I see failure here, generallly.

From our friend “Ignorantapothetic” The Rite-Aid official line.

“With the potential removal of Walgreens from the CVS/Caremark network, we have a tremendous opportunity, both on the pharmacy and front end, to win these customers over to Rite Aid. As health care professionals, we should gladly accept these patients and take the initiative to ensure they get continuation of care they deserve. We can help these new or returning patients by making transferring their prescriptions easy and seamless. Yada yada bullshit wellness+ propaganda here……..The best reason that Walgreens CVS/Caremark insured patients have for transferring their prescriptions to Rite Aid is YOU. You are part of the Rite Aid pharmacy team, a group of caring professionals, who provide outstanding service to our patients every day. Taking care of these new customers will help to win them over and bring them back!”

 

.

 

I have written before about the brief three day love affair that I had on the island of Mykonos in the Aegean Sea in December, 1976.  Her name was Heather.  She was from Ireland.  The people I was traveling with left for Athens and I stayed behind.  I thought that I was going to stay out there, a world away from any drug store and my trashy memories of my brilliantly failed first marriage. 

After two nights together, Heather announced, “I’m going back to Dublin.  I want to be home at Christmas.”

I thought about that.

Heather went on.  “I’m a good Catholic Irish girl, Jamie and these two days have me wantin’ some serious confession and repentance.”  She managed a smile.

“For serious?”  Girls in California didn’t talk about confession and repentance.  We were at a lazy harbor side cafe, smoking acidy unfiltered Greek cigarettes,  drinking milky ouzo and water and eating sausage, feta cheese and white bread.  The Greek men with long moustaches and Greek fisherman’s hats kept glancing at Heather.  A redheaded woman looking like her should not be so comfortable in a place usually reserved for men.  Alas, it was December and business was slow.  The owner, a young Greek who played rock n’ roll until we requested bouzouki music, made it clear that the Irish girl and the American Greek with some money were more than welcome.  

“Mostly serious.  It has been glorious, Jamie, but I have to go home.”

“I guess I should too”

The next morning we climbed up a ladder to the roof and looked out over the town and the harbor.   We hugged and Heather got teary and I clung to her.  We were smart enough to not share addresses.  It was brief, wonderful and over and we both knew it.

I am including that story to tell you:  If you are sick and tired and can’t take it anymore… Quit and go have an experience you will never forget.  You only have one youth and one life.  Live it for Crissake.

In 1976, there was no pharmacist shortage.  You couldn’t just show up at the front door, flash your license and get a job.  Yes, it was risky, but who cared?  I have always been a risk-taker and it has always paid off somehow.  In my case, I wanted a life when I was still young.  I was 35.  From November, 1976 until April, 1980 I did not work one full-time week.  I worked part time and honed my writing chops by writing down a couple really bad novels.

When went back to work, it was time.  I was ready.

  For the next twenty years, I did what you are doing.  I hated it sometimes, but I had a family then.

So, this love letter is to the unattached among you.  I’ll give you the advice given to Forrest Gump.

Run, Forrest, Run.   While you still can.

You’ll find a job when you come back.  You are not chopped liver.  You are good at what you do. 

.

.
.

1. Very short term gain. These patients, for the most part, will not remain loyal.

3. The usual, head-in-the-sand pharmacist move.

Regardless, we all need to thank WAG. WAG may be big, ponderous and slow, but WAG has always taken the high road. CVS, on the
other hand, would love to figure out how to get a six pack of beer, chips and four hot pastrami sandwiches through the Rx Drive Through Tube.
.

.
Only good can come from this. The CVS-Caremark merger was a low point of the pro-business Bush years. Directing patients only to CVS stores has to have anti-trust implications. I would hope that others will follow WAG’s lead. Independents, this can save you. WAG winning higher reimbursements would be the first domino to fall. You can bet that the PBMs are not sitting so comfortable in the lounges where they
pop the corks and light the big cigars. This is moving very fast. It will be a cage fight. I’ve picked my favorite. Yours?
.

.
6-9-2010…. I just read VGA’s comments and want to thank him for nailing it. I have done all of the things he mentions. You have a family, debts and a mortgage. The American dream means you have to work. Most of us are not bright enough to get into a condominium that is the perfect size and drive a modest car to work because it sits in a parking lot all day. We make big and we spend big. I have done both. In order to get along, I have done what my employer wanted me to do. I have unplugged the phones. I have told patients that the wait time is one hour when I know that 20 minutes is more likely. If an obese person in drive through can’tseem to get my counseling, they have to come into the store. If I think the counseling is vital, they can’t refuse counseling. VGA, we do what we gotta do. We don’t have to like it. So, when I get on your case, it is truly just an invitation to examine what you do, a mnemonic device, if you will. We CANNOT be unconscious about it. Every day, we
have to acknowledge the way it is. It can’t change if we don’t. The first step in determining WHAT YOU WANT is to recognize WHAT YOU DO NOT WANT.
.

Do I have this right? You don’t like it that your employer times your work on the “Prescription Mill”. You think that you should have all the time in the world to counsel your patients on all new prescriptions. The bastards won’t give you your three week vacation in July when your wife has hers. You don’t like it that you have to work a 14 hour shift, once a week, with not one uninterrupted meal/rest period.
.
You do not even have the time to go pee before it becomes an emergency how can they expect you to go out front and collect a bottle of APAP and some Preparation H to send through the Rx Drive Though tube. One big chain expects this. The other actually prohibits this behavior in its computer training.
.
You whine and cry and bitch and complain about your job. You protest that it shouldn’t be this way and, by gawd, you’d quit if you weren’t making close to $500.00 a day, with benefits added to that.
.
They are doing it to you and they don’t even kiss you before they stick it in. You throw up your hands. They are too big, too strong, too smelly, too rough, too stupid for you to do anything but be a big frikkin’ victim.
.
Here is what our good friend George Bernard Shaw said:
.

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

I love that shit. Wake the fuck up, you guys. You are highly educated professionals. Start acting like it. The idiot non-pharmacist store has no power over you. You just have to stop being a victim and start practicing pharmacy. ALL OF IT.

I love you guys.

Probably the 1970s.  Check out the Barber Jacket AND THE CIGARETTE IN THE RIGHT HAND. DISGUSTING!

From My Good Friend Quan on Facebook. A testimonial. 6/6/2010. There is now a Second Edition ready to ship. Click on BOOKS
.

Quan Tran, R.Ph. posted something on your Wall and wrote:

“Just finished reading your “20 simple rules” book that I ordered…about a year ago . Ya know, it was just like reading my own thoughts. Thoughts that were always in my mind but could never be written out so well. Hat off to you, sir!”