Are you weary of all of the TALK about abusive non-pharmacist managers?   Variety stores that happen to have pharmacies (CVS)?  Convenience stores that are killing their pharmacists off  (RAD?

Take a few minutes to watch this very short film.

The film could be no longer than three minutes, contain only 6 lines

of narrative & be a compelling story. The winner was “Porcelain Unicorn”

from American director Keegan Wilcox.

It’s a story of the life of two people who are totally opposite,

yet, have very much in common

You’ll see why it won.

First, You Have To Look Good.

An MBA Master of the Universe has to look like he knows something and he has to express his ideas with authority.  An MBA Master of the Universe must be prepared.  He needs to use pie-charts  or, better yet, Power Point presentations.   It does not matter if the Master’s ideas blow everything up and cause embarrassment and failure.  Like the Rite-Aid 15 minute guarantee.  At the meetings with the CEO and the executives, it sounded like a helluva good idea.  When it failed dismally, I’d bet that the MBA Masters of the Universe blamed it on the pharmacy staff, the pharmacists and technicians.

You can bet that the MBA Masters of the Universe who pose at Rite-Aid’s offices in Camp Hill, Pennsylvania did not get their MBAs at The Wharton School of Business at the University of Pennsylvania.  Wharton graduates are working on Wall Street at companies that have four names with no commas.  They are at hedge funds, brokerage houses or the investment banks.  They are not going to hitch their wagons to a broken down nag.  They are working for that million dollar bonus in January.

If the Masters of the Universe at Camp Hill got their degrees from a major university MBA program, I would be surprised.  Think night school, perhaps on-line.  Giving these people the creative reins has gotten us to the edge of disaster.   I know pharmacists who have MBAs.  Companies that offer pharmacy services should seek them out.  Hire them and listen to them.

When they say, “Sir, that PBM contract is a loser.  We would be, in effect, paying them for the privilege of providing prescriptions.  That is idiocy.  We cannot sign it”.

MBA Masters of the Universe look for ways to grow and for ways to cut costs.  They have no standing in the pharmacies.  They don’t know the difference between $1.40 profit from an Rx drug billed through ESI when the cost is $98.00 and a $1.40 profit for a cash Rx for 15 tablets of HCTZ 25 mg.  It is pathetic that they have the ear of the CEOs.  At Rite-Aid, the CEO has no standing in the pharmacy.  He is a grocer.  The nuances of our profession are a quantum distance from his paradigm.   What was the RAD board thinking?  How can they expect a man who was spawned as a grocer to guide a pharmacy-centric company out of the huge hole that RAD is in?

He cannot possible know what it is like to try to get five people a day to have flu shots in February.  Most of the older patients have already had the shot.  If they haven’t, they are patients who have said NO before.  This is a desperate policy to try to pump up the profits.  Desperation is a very unhealthy position for a company.

The MBA Master of the Universe who came up with this is probably in favor even though it was a stupid idea.  He has no idea.  He just knows that the profit on a flu shot is satisfying, a really good return on investment.  His plan is SELL MORE FLU SHOTS. And, if a pharmacist fails, fire her.  Fire her especially if she is a 20 year veteran, with lots of vacation weeks and the highest wage.  We have a list of new pharmacists who will take 15% less in wages and we can get away with holding back benefits.

The young Master of the Universe heads for the local go-to restaurant and bar for a few drinks with a couple secretaries and a guy from accounting.  After a few tequila shooters, he brags that his plan is win/win.  ”If they sell the shots, we win.  If they don’t sell the shots, we win because a high-priced pharmacist will be on the streets.”

A forty-something youngish man is sitting with his attractive spouse at an adjoining table.   He is retired military.  He frowns as he listens to the conversation.

His wife touches his forearm. “Please don’t, Chad,” she says in a whisper.  Her eyes warn him to relax.

Chad was in the Rangers.  Mogidishu was the worst experience of his life.  His shoulders tighten and then he relaxes.

Rite-Aid has traditionally thrown money at all of their problems.  Where do they get it?  Look at the RAD stock price.  What happens when Cardinal refuses to ship?  What happens when they don’t pay the medical insurance premiums?

A blonde with a husky voice at the next table asks, “Fire them?  Just because of flu shots?  That’s awful.”

“That’s business, Sugar.  Just business.  Survival of the fittest.”  Harrump, ha ha ha.

The music as a too loud thump of bass.  The singer is not Springsteen.  He is trying to sound like Springsteen.

Chad stiffens.  His wife studies his face.  The artery in his neck begins to beat stronger.  He smiles at her, but she has seen this before.  There is nothing that she can do.  She says that she needs to visit the rest room.

The Rite-Aid Master of the Universe cannot shut up.  Alcohol has loosened his tongue.  The secretary pushes his hand away.  ”What, don’t you like me?” he asks slobberly.  Then her eyes widen.  Chad is standing beside the Master of the Universe.

“What the hell do you want, asshole?”  The Master of the Universe drains another tequila shooter and laughs at Chad.  ”Get away from us.”

Chad’s arms are relaxed by his side.  ”I got my degree with the GI Bill,” he explained.  ”I am new to this.  I don’t think you will be able to get away with firing pharmacist for no good reason.”

Then, the tequila making him too brave, the Master of the Universe stood and went nose to nose with Chad.  ”What are you, a do-gooder?”  He put the palm of his hand on Chad’s chest and pushed, but Chad did not move.  Then, the Master of the Universe made a fatal error.  He threw a punch.

Bif Bam Pow.  A right to the ear, a left to the mid-section and a head butt and our Master of the Universe was on the floor.   When he came about, he hollered, “Call the police.”

His waiter, a small Puerto Rican named Ricardo said to Chad, “I am your witness.  He punched and you were protecting yourself.”  The Master of the Universe had called Ricardo an illegal alien.  Puerto Ricans are citizens of the United States.

Chad’s wife suggested that they go elsewhere for dinner.  On their way to the door, an older woman dining with an elderly friend said, “Aren’t you the pharmacist at Rite-Aid?”

What a brilliant fantasy, huh?

A young Master of the Universe wearing a nice suit can blow smoke with RAD’s CEO.  All the guy can do is nod his head, show airy fairy projections and a grocery store man will go along with it.

I’ll recap.  To be an MBA Master of the Universe you have to look good and you have to be persuasive.  You do not even have to have any evidence that your ideas will work.  If they do not work, if they fail, the pharmacisdt will be blamed.



Fred Mayer is the president of Pharmacists Planning Service.  He opened his Sausalito, California pharmacy in 1962.  That makes him older than JP.  Fred may be older than dirt, but his head is still in the game.

In the “Final Word” column in the February, 2012 issue of Drug Topics, Fred is the author of a column entitled: “Walgreens Draws A Line In The Sand”.  He ends by making the statement that Gregory D. Wasson, RPh, Walgreens CEO, deserves the highest accolade and award- the Remington Honor Medal – for drawing a line in the sand and emphasizing the need for reimbursement for pharmacy cognitive services.

Tell me what the Vulture CEOs deserve?  The PBMs absolutely must be made to play fair or pharmacy as we know it is done for.  So, what do we have?  Grocery Stores. Big Box Stores and Drug Store companies advertising, “We Will Fill Your Express Script Prescriptions”.  Pathetic.  Here is a chance and they blow it.  They are still locked in the idea that all we do is provide a product and the pharmacist is simply an expert clerk who runs the “Prescription Mill”. WAG, by the way, has a policy of sending Express Script patients to the local independents, if possible.

Take the time to read Fred Mayer’s Drug Topics column.  It is really good.  If you get the print edition, it should arrive any day.  If you do not get the digital edition directly to your e-mail in-box, there is a link in the column to the right.  Just click on the link and subscribe.  No charge.  The best topical source of news for the pharmacy industry is Drug Topics.  The “JP at Large” column for February is provocative and appealing, if I do say so myself.

I suspect that you all know that I label the PBMs as “The Vampire Squid” that needs to be fought and stopped.  It is OUR profession.  We have lost control of the business, but the profession is ours.

Yesterday, I took the time to take a stab at “The Vampire Squid”.  A patient brought in an Rx for 1,080 Methadone 10mg.  This poor guy is bent over with pain.  I mean BENT OVER.  He is not an old man.  He has some kind of rare skeletal malady and it will get worse.

His PBM denied the Rx.  Excessive quantity or excessive dose or something like that.  I don’t pay attention.  That is the technician’s job.  I have had jobs that required that I be an expert on third parties.  My last job in Vermont.  I was the pharmacist, the technician and the cashier.  I rarely did more than 100 Rx in a day.  I got on a first name basis with people at the PBMs help desk.  Not at this job.  There are enough technicians and why would I want to do their job?

This patient paid $208.00 for his Rx, but came back two hours later and told me that he called the PBM and was told that it would be covered if Yada Yada Yada.  I did not even listen.  It was 6:00 PM, I was working with one technician and there were people waiting at the register, Rxs on the counter to be verified, others to be filled and some asshole at the drive through who was having a hard time with my message, “Sir, the drive through is NOT an express lane.  It is a convenience and there are people inside the store who were here before you.  You will have to wait your turn.”

I told the methadone guy that I would leave a detailed message for the lead technician who will be in at 8:00 AM tomorrow.  He seemed okay with this.  I assured him that when the PBM paid, he would get his money.

Then, he said something that got my attention.  ”You don’t want to know what she said about you.  I told her that she was wrong.  You have helped me more than any other pharmacist.”

“What did she say about me?”

“She said that you don’t know what you are doing.”

I got her name and around 8:30 PM had the time to get her on the phone.  ”Brenda, do you remember Mr. Smith and his prescription for 1,080 tablets of methadone 10mg?”

“Ah… Yes.”

“Mr. Smith told me that you insulted me, indicating that I do not know what I am doing.  Is that true?”

“Ah.. I don’t remember that.”

“Why would Mr. Smith lie about such a thing.  Why would he make up a story like that?”

“Ah…..”

“…. Brenda, I have no doubt that you made a careless comment that denigrated me and my knowledge and ability.  If you like your job, you need to watch your mouth.  You work for “The Vampire Squid”.  Trust me, your company and the other PBMs do not run this ship.  Pharmacist are the sleeping tiger.  If we wake up, we will devour you.”

“I don’t know what you mean.”

“It isn’t important that you understand.  I know that this is being recorded.  I want your supervisor and her supervisor to listen to it.  In most modern pharmacies it is the technician who handles the insurance billing.  The technician is the expert.  My job as a pharmacist is to make sure that the patient gets the right drug, in the right strength, in the right form, in the right quantity.  My job is to make sure that the instructions are accurately recorded on the prescription label.  Then, it is my job to make sure that the patient understands what the prescription is for, the she knows how to take the medicine, that she is informed of any dangers or side effects.  If the computer alerted me that there may be a drug interaction, I have to ask her if she still takes the offending drug.  Brenda, I have my hands full being a pharmacist.  Why in hell would you expect me to do the job of the technician?”

“Well, I.. ahhh.”

“Not fast enough, Brenda.  Your line was, “I am very sorry, Sir.  My comments to Mr. Smith were inappropriate.  It will not happen again.”

“Ah, well I….”

“Are you an idiot, Brenda?  You need to apologize and mean it.  I could go after your job.  Your PBM does not want problems with me.  They pretend that they are the pharmacist’s partner.  Let me talk with your supervisor.”

Click, Brenda ran for the hills.

The Vampire Squid

As the lyrics in the 1960′s rock musical sensation said:

Enjoy the video. I can’t help myself. I was a closet hippie in the 1960s. Those years in San Francisco formed me.
This was the award (Tony) winning Broadway revival.

For 2,000 years, we were in the Age of Pisces. It was an age noted by suppression of women. Women were dominated by men. Husbands, fathers, uncles, teachers, priests, pastors. The society was noted for keeping women “In their place”.

Sandra Day O’Connor was at the top of her Stanford Law School class. The only job she was offered was a secretary’s job at a law firm. She eventually served our country as a Justice of the Supreme Court of the United States. How do you say, “Sick Your Secretary’s Job” politely?

I’ll get to the story, just hold on.

The song up above moves me. I went to the original play twice at a theater on Market Street in San Francisco in the late 1960s. I so want the Age of Aquarius to play out. The Age of Pisces was 2,000 years of silence, lies and hiding the truth. It was easy. There was no Internet. The Age of Aquarius started at the turn of the century. The Internet was blossoming. All of a sudden, the truth was right there, in your face.

One succinct political comment: What are these idiots thinking? All employers (the Roman Church included) are compelled to cover the pill with zero copay. At the congressional hearing today. There was not one woman on the five person panel. Darryl Issa of California was the Chairman. It was a set up.

The Age of Aquarius in “in your face” of the idiots. This will be a 2,000 year age of truth and clarity. Women will take a rightful place, equal to men. It has already started. Women are the majority of new pharmacists. Women can give birth, men can’t. Women are the ONLY ones who should be testifying before the Congress.

Santorum’s money man, Foster Fries, said on MSNBC, “Women can use a inexpensive drug. Aspirin. They can just put it between their knees”. He also claimed that making “The Pill” illegal would be best. How do you spell ASSHOLE. Actually, this is serious shit.

Last week, a couple asked for Plan B.  I brought it over and, after counseling, I rang it up.  I believe that these kids were wither medical students or students at Texas A&M Galveston.  She was an attractive woman with a Hispanic name.  He was Hollywood handsome.  Longish hair, dark clothes with a 2 day beard.

When I asked for the money, he said, “Can you separate that for two credit cards?”  He paid half and she paid half. I was impressed, but I did not make a big deal out of it.

Later that day, it was a month of oral contraceptives.  Again, they handed me two credit cards.  Now, I had to say something.

“I am impressed, you guys.  For 50 years, birch control has been the responsibility of the woman.  You are the first egalitarian birth control couple I have met.”  I told them about the Age of Aquarius.

They were shy.  They nodded and looked at each other.

This is the “Dawning of the Age of Aquarius”.

This has bothered me for a couple weeks now.  For me, it is an indication of what has been happening in our industry CVS threw this guy under the bus.   He has  been left to die.  I do not believe that he has recovered.  He may never get back.   After a careful look, I think he may be homeless.

I went  over to the counter to cousel him on an Rx for 15 Hydrocodone/APAP 5/500.  

The Technician looked at me and said, “It comes to $8.78, Jim.  He only has eight dollars.”

He had one of those I-Am-At-Your-Mercy looks on his face.  On the counter were four one dollar bills and a neat pile of quarters.  It was every penny he had.

I made eye contact and said, “This company will not let me give thi prescription to you for anything less than $8.78.

He looked a me and I thought how I would feel if he was my son.  The prescription was legitimate.  15 tablets is not a quantity that a drug seeker would be looking for.  The doctor was not at a discount clinic.

He said, “I understand.  I was in management for Eckerd.  I know how these big companies are.”

“Which Eckerd?  The one down the street.  The one that was fucked up by CVS?”

“Yeah, the one fucked up by CVS.”  He actually smiled.  “They fired me when my wife had a miscarriage and I took a day off without getting an approval.”

“I’ll tell you what.  I will give you 5 tablets from your bottle.  You can pay the $8.78 and pick up the other 10 tomorrow.”  When I handed him he vial with 5 tablets, I asked him.  “Did you very have a child?”

“You gotta have a wife,” he said.  “She fired me too.”

The next day I was certain that he was homeless.  He was not dirty, but he needed a haircut.  He was wearing the same clothes.  He had the same four one dollar bills and 16 quarters on the counter.  The look on his face was utter surrender. 

“I will front you the 78 cents,” I said.  “You can cover it later.”

He thanked me profusely.  His body language reminded me of someone who was expcting a beating.  I don’t think that this youg man had any hope for the future.  He was done at 30 years old.

This young man is not a pharmacist, but I have been reading  horror e-mails from RPhs who have been fired or relocated or been assigned to the float team over nothing.  Rite-Aid pharmacists put their job in jeopardy if they do not “sell” six flu shots every day.  There is no way to “sell” six shots every day.  Eventually, you will run out of people.  Not everyone wants a flu shot.  You are going to piss people off.  Another terrific bull shit idea from the non-pharmacist MBA Masters of the Universe in Camp Hill, Pennsylvania.  What can we expect when the CEO was spawned in the grocery business and has absolutely no standing in the pharmacy world.   Flu shots are like onions or ham hocks.

I have read letters from pharmacists who are driven to distraction by the “metrics”.  Another terrific idea of the non-pharmacist MBA Masters of the Universe.  The computer programs now spyon your every move.  You do not practice pharmacy because you are consumed by the metrics.   Have pharmacists really been fired because they do not keep up?  What if they take three minutes for counseling? 

Wal-Mart has decided to get rid of really good pharmacists who had a substance abuse issue in the past, but have done what is needed and wanted to clear their name.  Wal-Mart calls them in and bam, you are gone.  Whusingat is with pharmacy?  Doctors who make the mistake of abusing drugs are directed to treatment.  They are not treated like they are criminals.  It seems that pharmacists are just killed off.  They put you in charge of the candy store.  The conditions are unprofessional and highly stressful.  The lorazepam is on the fast movers shelf.  I believe that the statistic is 47% do help themselves.

This frikkin’ depresses me.   The Eckerd kid may as well be dead.   There are pharmacists who are treated like peices of shit.  How is this called a profession?  Too many people are blind.  Selective vision.  The three monkeys.  Just because you do not see it doesn’t mean it could never happen to you.

No doctor is going to keep an inventory of $200,000.00 of drugs to dispense.  The Med Box will be limited, like the little green Med Box that this guy keeps.  Doctor dispensing, due to financial constraints, limits the doctor’s choices and leads to poor care.  Jay Pee

You’re sick and in your doctor’s office. Why not pick up your prescription while you’re there? Convenient, safe and hassle-free. Avoid the extra trip to the pharmacy. Start your treatment immediately; you can begin taking your medication while in the doctor’s office. Ask your questions of the pharmacist, physician and nurse all at the same time.

The current physician-pharmacist-patient triad is a highly inefficient and expensive healthcare operation. An often-sick patient must drive to an often-distant pharmacy to have it filled. Each step underutilizes expensive professionals due to inefficient operations and administration. Pharmacies must be conveniently located and must stock extra inventory to be prepared for any prescription from any physician, adding to the cost of medication.
MedBox provides a Web-based, fully automated, video-conferenced, robotic prescription dispenser for an individual physician’s office. Patients can have prescriptions filled by their pharmacist while at the doctor, plus obtain refills at any participating MedBox Automated Dispensing Robot (ADR). The ADR accepts prescriptions in any media format: electronically, on paper, by phone or fax. MedBox ADR counts, pours and dispenses exactly the quantity the physician prescribes, giving a physician full control over therapy. ADRs are modular, sized to fit in a doctor’s office and manage inventory for one physician; group practices can be served by several ADRs.Inventory is customized to the physician’s practice, minimizing surplus stock.
The current prescription market generates over $200 billion in sales, with 60,000 pharmacies (and the largest chain having 10% market share) reporting average revenues of over $3 million per pharmacy. The current physician market has 200,000 general practice, physician-owned offices with average revenues of $1 million/office. MedBox will strive to acquire a 10% share of this community pharmacy-physician-prescription market through the use of a technologically advanced paradigm that puts the pharmacist and medications in a doctor’s office using robotics and Web technology.

Just another strategy to increase revenues for “Fee for Service” doctors.  Bad idea for the patient.  The doctor’s Aunt Minnie’s cousin’s second daughter will do the dispensing no matter what Med Box says.  No pharmacist oversight, but what the hell, there is rarely pharmacist oversight at the drug store.  Pharmacists are too busy counting beans.