What happens when you need to counsel on an Rx and you just went to your lunch?  Does the Tech tell the patient to wait for 25 minutes?  This is not good and probably violates more than one counseling law.  How can the state of Pennsylvania allow this?  Probably written by one of the MBAs over at Rite-Aid.

Pennsylvania Law:

(1) The pharmacist shall remain in the pharmacy, or in the case of a pharmacy located within a retail establishment or institution, in the immediate building containing the pharmacy, and shall be accessible for emergencies or for counseling, if requested. For purposes of this paragraph, the term ‘‘immediate building’’ means the physical structure that contains the pharmacy. A pharmacy located at a complex consisting of multiple retail and other business establishments, such as a mall, is not considered to be ‘‘located within a retail establishment.’’ In that case, the entire store containing the pharmacy is licensed, and the pharmacist shall remain in the store during a break.

(2) The pharmacy may remain open during the pharmacist’s break for patient-related services, including:

(i) The receipt of new written prescriptions.

(ii) The preparation of prescriptions for final verification by the pharmacist.

(iii) The delivery of prescription medications that have been verified by the pharmacist.

Peter, how am I going to sell any books if you are giving it to them for free?

He talks about developing a niche business.  On September 2, 2011, the FDA pulls 500 Rx-only cold, cough, allergy products from the market.  You know which ones they are.  Nothing special other than the price. Good riddance.  That leaves only the OTCs.  Who is dumb enough to go see a PA with a cold and get a recommendation for an OTC when you will do it for nothing.  Big sign in your window:  ”Cold, Cough, Stuffy Nose Medicine Advice Here”.

The boomers will not age gracefully.  They demand to be youthful, vibrant and sexy for the whole ride.  If you can help them do that, you have a profitable niche.  Bio-equivalent HRT if you compound,  Nutrition support.  You can figure it out.  You just quit thinking when you went to work for the chain.

Stay out of debt.  Drive a Focus or a Civic.  Rent for awhile.  If you buy the Lexus, the 3,000 square foot on the lake, you will be a “Prisoner of Comfort”.

Here’s what Peter had to say:

I used to be faculty at a school of Pharmacy and students would tell me that everything they learned in class was a waste of time, because in the real world, there’s no time to counsel. They acted like indentured servants. Year after year, I tried to remind them that they were the licensed professional, not a slave. But they had become institutionalized.

I opened my own pharmacy. Was I scared?  A little. But that fear is what corporate pharmacy relies on. Fear of losing your job. Fear to take a calculated risk and open your own practice. Fear of the unknown. A little fear is useful, but the amount of fear within our profession is COUNTERPRODUCTIVE.

If I, with no real previous community pharmacy experience, no business training, poorly financed, primary bread winner, poor location in the middle of the worst recession in 50 years, can succeed, surely you guys with tons of experience can.

What is holding you back?  FEAR! It is easier to criticize corporations and boards of pharmacy from behind a comfortable paycheck and miserable job. Think of all the patients that either storm out of your pharmacy or another pharmacy due to bad service because the corporation’s poorly thought out staffing and protocols.

These patients would get better service/care from you and would become loyal patients. The average gross profit on a Medicare Part D Rx is about $11-12. Using that as the “worst-case scenario” you can easily figure out how many Rx’s per day you need to pay your bills, salaries and overhead. If you’re not getting gouged for rent, you can survive on about 2100-2200 Rx’s per month. That’s about 100 Rx’s per day. I know most of you are filling 200 per day or more with just one tech. If you focus on service, clinical care and possibly a niche, you can build a nice practice, have ALL debt paid-off in 2 years and start building a nest egg. You will have to give up the nice cars and nice vacations for a while. If you don’t have a big fancy house yet, hold off for a while. If you’re a recent grad, continue living like a poor student for 3-4 years. There is no greater freedom than being able set your own hours, policies, service model etc. Yes, there are risks. Some will fail, even with the best plans.  Take it from me, the upside GREATLY outweighs any downside.

Faculties of pharmacy do a good job at giving you a base to practice anywhere. The issue that my former students pointed out is that they had become glorified techs. My bigger concern is that faculties are turning their students into sheep. Our profession needs more lions. There is always the risk that payers will cut back reimbursement, but there’s also the hope that clinical billing becomes a reality.

There will never be a perfect time to open a pharmacy. I rolled the dice with two small kids, big mortgage and little experience. I was hoping that passion, patience and creativity would be enough. In my case, I was lucky. And if there was a well established indie near you that closed, 99 percent of the time this is not due to a problem with the underlying business, it’s usually the owner got into something he or she shouldn’t have(drugs, booze, gambling, leveraging the pharmacy for other businesses that fail). What you should consider doing is taking over the location.

My  location is urban in Windsor Ontario. I have two chain pharmacies sharing my intersection. I have about 11 pharmacies within two miles of my pharmacy. The main issue for me was not the location. It was developing the niche services and marketing them effectively. I became a primary destination, not an afterthought after receiving a prescription.

Check out www.novacare.ca for more info.

Jay Pee at hour 12 of a 13 hour day. He just put prochlorperazine in a bottle labeled promethazine. The bottles were right beside each other and both by Sandoz. .

This initiative is designed to get TPA members to participate in a singular project. That is get the state boards to act to protect the public from dangerous pharmacists. The state board will never allow a pharmacist who is impaired by a couple cocktails at lunch to practice pharmacy. Why do they keep blind to pharmacists who are impaired after 12 hours straight, no meal or rest breaks, 300 Rxs in the pot and still two hours to go with no technician help?

The state boards are mandated to regulate pharmacy so that the public is not put in jeopardy. Let us demand that they do their job.

I am asking all members to get onboard. The more hands and brains aligned, the more significant our initiative will prove to be. This will be almost exclusively Internet driven. After we have compiled the evidence, I will ask our attorney, Paul Garbarini, to prepare documents to be entered into the record that hopefully will pucker up some assholes.

Demanding that the state boards of pharmnacy accept that a tired pharmacist is a dangerous pharmacists is what we will focus on. This is the turd in the punch bowl. Everyone sees it, but too many board members represent retail chains. Board members know that this is a problem, but they will continue to try to ignore it. Our job will be to put it right on the table where they have to see it. Statements from pharmacists will mean something, but statements from the public, demanding that the state boards dotheir job will be huge.

Visit: www.thepharmacyalliance.com

My primary job is to be rude to medical office staff

I am too often accused of being rude when what I am doing is advocating for the patient’s benefit.  My business-like manner gets accusations of, “You are so rude”.

An elderly woman handed me a piece of paper.  On it was “AKIBAN 0.5 mg”  She said that her sister had died the night before and her doctor had advised her to go to a drug store and have the pharmacist call her.  ”I’ll prescribe this drug.   Write it down and have the pharmacist remind me.”  She certainly spelled ATIVAN.

I wanted to help this woman.  I stopped what I was doing and called the office.  The woman who answered the phone was certainly not a nurse.  Her telephone manner was imperious and I was offended.  She told me that the doctor was busy and that she would give the message.

Hold on,” I said, “This woman is upset.  Her sister died last night.  She talked with the doctor.  You can’t just put a note in the doctor’s pile.”

“This is how we do things here.  The doctor will get to this when she can.”

“Didn’t you hear me?  This woman talked to the DOCTOR.  The doctor said to call.  She is 80 years old.  She lost her sister.  She is upset and that is reasonable.  You can’t just let her twist in the wind.  This once step out of your comfort zone and do something good for the patient.”

“You are so rude.”

WTF.  Why am I rude when all I wanted to do was to help this woman?  The bigger question is why am I a piece of medical care shit?  What have we do so wrong to allow people to think that pharmacists are the slaves of medical care?  I’d guess that the $4.00 prescription adds to the low level of respect we get.  Dollars off coupons for transferred prescriptions certainly makes us look like carnival vendors.   “Hey you, where’s the Bud Light dat’s on sale?” certainly shows the respect we get.  What have we done wrong?  Where has the APHA failed us?  That insular, incestuous organization that won’t stretch beyond its strict borders.  The schools that gorge on corporate money.  Are they putting out new pharmacists who have pride, maybe a little chip on the shoulder?   It is still a mystery to me.

Part One from 4 years ago.

Part Two

Our friend Davey. His heart has seemed weaker lately, but I know this man. He has the same animal in him that Jay Pee and many of you have. You wouldn't be reading this if you weren't up to getting Pharmacy Back!

This letter was written to a young woman who represents a public relations outfit in New York.  She has been recruiting Jay Pee to be a featured player in a media tour next fall.  Ostensibly, my job will be to talk about coughs and colds and sore throats.  I will be representing a major OTC brand in the cough, cold, etc.  It will be in an interview situation on shows like “Good Morning America”.  We are early in negotiations right now.  The one thing that is set in stone is that Victoria travels with me.  I do not do well at my age in a hotel room all alone.  It is hard enough to sleep on a strange bed.  Impossible alone.  My intention, if this works out, is to make you guys into heroes.  Below is a letter I sent to this young woman.  Put in front of a national TV audience, this is the horse I intend to drive until it drops.  Can you see the future?

Sxxxxxx,

The days of seeing a doctor for a common cold are over.  Doctors do not have the time or inclination to treat patients for something so trivial.  The cold is an illness that will get better in all cases.  Doctors are going to be reserved for real diseases such as seizure disorder, osteoarthritis, COPD and such. They will also be very busy with patients who are healthy, but do not want to put up with age-related inconveniences like erectile dysfunction.  10,000 Americans turn 65 years old every single day.  There are 44 million boomers.  Big Pharma will make sure that there are plenty of drugs to help keep them vital, youthful and sexy.  There will be big money in boomer medicine for Pharma and the physician and, as we know, profit is the engine that drives the train.

It will be nurse practitioners and physician’s assistants who will treat patients with type II diabetes, high blood pressure and other pedestrian conditions.  It is counter intuitive, but the PA and the ARNP will NOT be treating the common cold because they will have nothing to treat it with.  On Wednesday, March 2, 2011, the FDA ordered that about 500 prescription drugs used to treat colds, coughs and allergies be pulled from the market.  They had never been approved for safety or efficacy.  There will be no prescription-only cold medicines left.  Pharmacists have known for decades that these products are nothing special and are grossly expensive.  The manufacturers were given 90 days to stop manufacturing and 180 days to stop distributing.

The average patients are smart.  They will soon ask, “Why should I pay $100.00+ for an office visit to have the PA prescribe an over-the-counter medicine when the pharmacist will do it for nothing?”  On top of that, the pharmacist is the expert and knows a lot more about these products than the nurse does.

The pharmacist will very soon be the primary care provider for all colds, stuffy noses, sore throats and coughs.

I have been in love many times.  I have been in LUST a few times.  The “in love” experiences were mostly satisfying, but, for a young man, they did not have the spark of the “in lust” experiences.  This is more of Jay Pee’s advice for you young ones.  I went for LUST in the few long term relationships I had before Victoria.  With her, my lust bones were pretty well rounded off and, although we have enjoyed each other that way, there was no urgency.  My first two marriages were lustful affairs and I bet the farm on each of them.  The first one was an example of a man driven by his testosterone and gonads.  I had no idea how wrong I was until 9 years later when I escaped, a shell of the JayPee you know today.  On retrospect the best relationship was with a pharmacy student whom I respected very much.  We spent a lot of time together the last six months of school.  There was a spring picnic for the senior class at a park near Detroit.  These was food and beer and softball.  This young woman and I spent some time sitting on the dock of the lake, letting our feet dangle in the water.  We held hands and whispered, our heads occasionally touching.  I liked this girl a lot.  After the picnic, at dusk, we got in my Volkswagen Bug and started for Toledo.  After about three hours of driving, I had sobered up and said, “How long should it take to get to Toledo?”  She admitted that our conversation had been so good that she lost track of time.  The next thing we knew, we were parked beside Lake Michigan.  We had driven in the wrong direction.  We found an all-night diner and got some food and coffee, put on our sweaters and sat on the beach until sunrise.  That was when an important moment happened.  I asked her if we should get a motel.  She smiled, but was much too much the good girl to say “Yes”.  I probably could have pushed it and gotten my way because I found out later that she was in love with me.  Maybe even in lust.  I was not in lust, so we went back to Toledo.  On the day, I married my first wife, lusting for the wedding night, my good friend Tom showed me a letter from the good girl.  She was heartbroken and wondered what she had done wrong.  I was an idiot and paid a huge price for 9 years.  The lust, by the way, was softened.  My wife was an alcoholic, an incest victim and not suitable to be a anyone’s wife.  The girl in Toledo may be dead as far as I know.  I asked about her in the 1970s and was told that she was a married woman with with children and suffered from MS.  I still love her to this day.  With lust out of the way, I love her a lot.  Here is my best advice.  I’ll direct it to the boys and you girls can put it in feminine language.  Go out and fuck yourself crazy, but listen, YOU DATE THE STRIPPER.  YOU NEVER MARRY THE STRIPPER.  YOU MARRY THE GOOD GIRL.  With women being so sexually aggressive in 2011, listen to me.  One of you might actually take my advice.  That will make what I did have some value.

Overworked, not enough help, ignorant patients. Take one of these and go to Italy.

I had an audience and I was going to get the best out of it.  I told this middle-aged man, well dressed that his prescription for 7 tablets of Levaquin was going to take 30 to 45 minutes.  He loudly played to the 6 people standing around and said, “What the hell, it is 7 lousy tablets in a bottle.  45 minutes, come on.”

“Don’t talk to me about 7 tablets.  There is a helluva lot more to getting the prescription to you than counting 7 tablets.”

“What the hell is so complicated?”

“I am going to make sure that you and everyone else gets the right drugs, in the right dose with the correct instructions.  I am going to do that with only one technician and with the phone ringing.  I am going to make sure that it is not a dangerous drug for you…..”

“…This can’t be a dangerous drug.”

“…Almost every drug we dispense is a poison if you take enough of it, often enough… I’m going to make sure that you the prominent side effects as I stop often to answer questions like this… ‘Hey you, where’s the beer and bacon that’s on sale?’  I will counsel all of you when and if it is appropriate.  I will cashier if it is needed.  I will attend the drive-through.”

“I still think that 7 tablets shouldn’t take…”

“I told you not to talk to me about 7 tablets.  All of these people are ahead of you.  They are waiting patiently.  Some people have left and will be back soon.  I don’t have time to waste on you, and tell me this:  Why would I ever want to give you special attention after you have demeaned me as a medical professional and insulted.”

“Well, I didn’t know…”

“That’s right.  You didn’t know.  Your prescription will be ready in about an hour.”

Six people gave me big smiles.

New at CVS, Personal health checks

This from a “chica” in Texas.

The Rx belongs to the patient, not CVS.  I think I’d enjoy this.  ”Mr. CVS Pharmacist,” I would say, “Who gives a shit what CVS wants. We follow the law.  When this patient complains to the state board, I want her to use your name.”

Yesterday, some “RPh” at CVS asked me for my state license number to complete a transfer. I flatly refused, saying that was not state law. He claimed he could not complete the transfer without it. I had two transfers and gave him two random 5-digit numbers as my license number which, I’m guessing, he just added without thought.