You all know that Jay Pee is an old hippie.  I lean toward  the “New Age” and have been known to say “Whoa” when I see something that is really cool and unexpected.  Life is exciting with an open mind (but not so open that my brain falls out).  I acknowledge that we are only 12 years into the Age of Aquarius.  This will be ten centuries of openness and honesty.  Women will share leadership and communication of the truth will be electric all around you.

The ten century Age of Pisces is over.  That was a millennium of lies, cheating, suppression of everyone if they did not agree, especially women.  The ghastly examples of putting heretics on the rack and women who were labeled as witches to the stake and burned come to mind.  People who had not earned power clung to power.  In the Age of Pisces you could bring light to dark places by writing letters.  Dark places covered the earth and our profession.  If we saw into the darkness and wanted change, what could we do?

That has changed dramatically with the Age of Aquarius and THE INTERNET.  We can wash dark places with brilliant light and have it spread like wildfire.  There is nothing that THEY can do about it.  Still, THEY cling to the darkness.  Do they think we are idiots?

We can wash them away like a tsunami if we just bring light.  That means YOU.  Regarding the  Kxxxx Hxxxx, XXX and North Carolina BOP.  Go ahead.  Bring the brightest light you can bring.  This is a patient safety case.  If you contact the board, make your respondent Jay Campbell.  This board is OUR board.  No member is an executive of CVS, RAD or WAG.  They are regular pharmacists.  If you direct your message to a particular member, that member may have to recuse him/herself.  We don’t want that.

What is the best way to bring light to the dark places?  The media.  What we have done has not worked so far.  What we have done is to enlist the help of pharmacy associations.  Don’t hurt yourself laughing.  We went to the boards directly.  We did get responses.  Priscilla Gale, a member of The Pharmacy Alliance, gave a presentation to the Virginia Board of Pharmacy. Her message was the TPA message: A tired Pharmacist is a Dangerous Pharmacist. I spoke with Priscilla this morning. I thanked her for her efforts in serving all of us and the profession. She reported that the board essentially blew her off. When the VA BOP responded to our message with an invitation to make a presentation, they did not expect anyone to show up. Priscilla spent her entire day. She had to prepare. We all need to acknowledge her and to follow her lead.

There are no rules.  If you live in North Carolina, you have to step up.  A letter to the editor of your local paper.  A message at your church.  Light up the dark places any way you can.

I do not want to take any chances of “Information Distortion” altering this message.  I am not willing to gamble that some of you may say, “Jim Plagakis said……..” and mess it up so I will be very short and to the point.  Remember the party game “Telephone”… Information Distortion.

Your career and the control of our profession just may turn on how the North Carolina Board of Pharmacy rules in the care of Kxxxxx Hxxxxx and XXX Pharmacy.

There will be a hearing in a few weeks.

At that hearing Kxxxx Hxxxx will be presented with charges that he violated the Pharmacy Practice Act.  I assume that these charges were presented to the board by XXX Pharmacy.

At that hearing XXX Pharmacy will be presented with charges that the company violated the Pharmacy Practice Act.  These charges were presented to the NCBOP by Kxxxx Hxxxx.

If Kxxx Hxxxx is cited and the company is not cited, you and me and every other pharmacist loses big.  We no longer have any control over our profession.  The questions in this case are not business.  They are professional.  If Kxxx is cited and the company is not cited, the idea that the board is there to protect the public is proven wrong.

If XXX Pharmacy is cited and Kxxx is not cited, we win and it will be the start of something big.

If both XXX Pharmacy and Kxxxx Hxxxx are cited, the NCBOP is caving to a corporation and agreeing with Kxxxx because they have to.

Watch closely.   This will affect you……

I asked Kxxxx Hxxxx if there has been any resolution to his complaint to the North Carolina Board of Pharmacy.  He previously asked me to keep him anonymous and not mention the name of the drug store chain.  I do not think that applies because he is not pursuing a wrongful discharge suit, but until he tells me to use his name, I won’t.

What good is the NC 12 hour maximum law if XXX pharmacists work 14 hours?  What good is the law that makes the pharmacist the “law” in the pharmacy?  What good is the NC law that mandates that the pharmacist perform her/his duties in a manner that protects the public?

Letter (To The Editor) Drug Topics, November 2011

From: David Work, Executive Director Emeritus, North Carolina Board of Pharmacy

David Stanley made some good points in his column about CVS in North Carolina.  I was Executive Director when the 12 hour rule was adopted and applied.   This was a direct result of a dispensing error made at an Eckerd drugstore by a pharmacist working a 16 hour with no meal break and/or scheduled bathroom break.  Eckerd claimed that she “volunteered” for this shift.  We also implemented a polcy, based on a Rule, which limits the number of prescriptions per day per pharmacist.  I believe it would be in the interest of public safety for other states to take similar actions.

All very nice, Mister Work, but, since you left, the NCBOP seems to be the three monkeys.  The Kxxxx complaint is 250 days old with nothing resolved.

The guy to ask is:  Jay Campbell, Executive Director NCBOP        jcampbell@ncbop.org

Kxxxx Hxxxx was getting Rxs out at a rate of one every 80 seconds.  His experienced technician was sick.  He could not safely continue.  He closed the drive-through.  The non-pharmacist store manager usurped Kxxxx Hxxxx’s legal authority and opened the drive-through.  K closed the pharmacy and was fired.  Kxxxx and his wife have triplets.  They are toddlers.  For a period, the stress of not having an income was over the top.

I do not know if any pressure brought onto the NCBOP would help – I would have thought the massive email campaign you engineered would have been enough to spur them to quick action, but apparently not. I suppose it is possible they are orchestrating a massive investigation – but I find it unlikely. Time permitting I will call them again to inquire this week or next week.  I will let you know what I find out.

Davey, a student who understands that he has at least 50 years ahead of him with his feet on the floor, asked what he can do to help Kxxx.  All of you can communicate your outrage to the Executive Director of the NCBOP.  This is the letter I mailed last July.  Please do not copy it verbatim, but you can use the information.  This is an OUTRAGE.  We need to hold the feet of the NCBOP to the fire.  The question is: “Has CVS bought the board”.  I am an idealist and I believe that we MUST DEMAND that all state boards live up to the mandated purpose to protect the public.

July 11, 2011

North Carolina Board of Pharmacy

6015 Farrington Road, #201

Chapel Hill, NC 27517-8154

This letter is a request that the board review the circumstances of the firing of Kxxxx (North Carolina licensed pharmacist) by CVS.  We request that the board give consideration to the facts and intercede on Mister Hxxxs’ behalf.  Mister Hxxxs was a trusted and competent pharmacist in charge for CVS.  When he made a decision in an effort to assure patient safety, Mister Hxxxs’ authority to close the drive-through was illegally usurped by a non-pharmacist.  At this point, Mister Hxxxs realized that the situation in the pharmacy was dangerous and untenable and he asserted his responsibility to make sure that patient safety came first and he closed the pharmacy.  The board will recognize that this was his legal responsibility.  He had no other viable choice.

Mister Hxxxs reports that at hour seven of a fourteen hour shift, he had already reviewed and verified over 300 prescriptions.  His intention was to counsel appropriately where the law required.  That is one prescription every 84 seconds, with inadequate help.  There was no uninterrupted break for nourishment or even a bathroom break.  Clearly, Kxxxx was compromised.  It is to his credit that he took action as North Carolina Pharmacy Law requires before a patient was harmed.

The Board of Pharmacy is mandated to regulate the practice of pharmacy in a manner that protects the public from harm or potential harm.  CVS consistently operates in a manner that not only disregards North Carolina Pharmacy Law, they flaunt the law.

I specifically point to: -21 NCAC 46.1804(b) and -21 NCAC 46.141(b).  The non-pharmacist store manager has absolutely no authority within the pharmacy.  Mister Hxxxs determined that the conditions obviated his providing safe and effective delivery of prescriptions and made complying with counseling legal requirements impossible.

CVS is well known as a Goliath company that bends and breaks the rules. It seems that this is the corporate culture.  The Federal pseudoephedrine sale recording requirement is a case in point.  CVS agreed to pay a $77 million fine for neglecting to abide by the law. CVS flaunts the law at every turn.  The executives in Rhode Island seem to be invested in only one thing, the bottom line and they will do anything, legal or illegal to get what they want.

It is a sad commentary that such a big player in the retail pharmacy universe gains a competitive advantage by cheating.

In the case of Kxxx, CVS broke the law.  It cannot be any more clear.  They cheated and they are probably cheating all over North Carolina.  In this one case, they must be held accountable.

I urge the North Carolina State Board of Pharmacy to waste no time in taking effective measures that will give Kxxxx and his wife some relief as well as assuring, by example, the citizens of the State of North Carolina that disregarding the law, by any drug store company, large or small, will be punished.

Jim Plagakis

Come on, you guys.  Step up.  Your professional life depends on it and I am not overstating.  The is no “Other guy” as in “Let the other guy do it.”  If the NCBOP rules against CVS, the dam will be broken all over the country.  Jay Pee

Poor Suckers Actually Believe This Kind Of Hype.  They believe that their Junior College (Or high tuition for-profit school) is going to make them a “Pharmacy Professional” on day One.  Most of them come out of “college” not knowing how to answer the phone, choose the right generic or how to fix a a PBM reject.  Only three important aspects of the Technician’s job.  What is really ridiculous is the expectations that their “college” brainwashes them to believe.  They actually expect to make $16.00 an hour right off the bat.  They expect their job to be “professional” and important. (First the job of a Technician is not a “Profession”.  It is a “Trade”). Second, a kid right out of “Technician College” completely unprepared for retail.  They need to be trained on-the-job.  Why spend way too much money to go to a “college” in the first place.

All of the Technicians I work with were trained on the job.  All of them are Efficient (They do things right).  They are also Effective (They do the right things). All of them are “Certified” and the jury is out on the value of  certification.  Especially in retail.  We have two girls in the store who are “Certified” who do not work in the pharmacy because they can’t hack it.  Occasionally, they are asked to come back to cashier.

Now, a story that indicates that Technicians need to remember their place.  They are not pharmacists and they need to mind their own business.

Sorry for the insult, but is it really an insult to point out the wart on the end of your nose, if there is a wart?  The way this business is progressing (and the fact that the shortage is dwindling), do you believe that you can still make six figures if all you are is a “Warm Body With A License”?  You cannot delegate your professional responsibilities and the Eric Cropp incident is a cautionary warning.  You may not allow a child to die, lose the privilege of practicing pharmacy, become a scapegoat for the OHIO legislative and regulatory failures and be thrown into jail to do hard time and be a girly girl friend for a six foot five, 280 pound guy they call “Bull”, but your ass could be grass if you allow a Technician to do anything that comes close to practicing pharmacy.

Technicians can become really comfortable.  They hear you saying the same thing over and over when you are counseling.  What can be the problem with advising a patient with the exact words you use?  First: it is illegal.  It is practicing pharmacy without a license:  Second: It diminishes your role as the professional.  Third: the technician can get it wrong.  Especially if the patient asks questions.  Tom, a mature man, is a smart rat technician.  He barely listens to them.  ”You need to talk with the pharmacist,” he tells them.  He gets an inordinate amount of questions because he is not a kid and they think he is a pharmacist.

I learned to listen to everything when I managed a small drug store in Pacheco, California.  My ears were still good.  I was in my early thirties.  Age and lots of loud rock ‘n roll, back in the day, leave me saying, “huh?” “What did you say?” or “Please speak up”, especially on the phone and forget  it if they are on speaker.

In Pacheco, I caught a pharmacy technician giving a personal friend a discount on an OTC item.  A giggly blond stood off to the side planning a weekend liaison with a guy who drove a Corvette, dressed like Joe Namath and was married.  They were meeting at The Sahara Tahoe Hotel at South Shore Lake Tahoe.  I didn’t say anything until we worked together one evening.  I was masterful bringing up the dangers of conducting an affair with a married man.

Too many times, I have heard a Technician giving medical advice and counseling on Rx Only or OTC drugs.  That shit does not fly.  I am all over them.  Not on my watch.  The pharmacist who overtly allows this or covertly looks the other way is an idiot.   This is your turf.  Protect it.  If your don’t protect your turf, you may lose that turf.  The entire profession could lose its turf.  Our situation is precarious.  Pay attention before the lemmings rush you off the cliff.

This weekend, the Technician was at the drive through and I heard this:  ”Take one pill today and one tomorrow.”  It was pretty clear what was being sold, so I asked.

“Plan B”

I said, “I do not sell Plan B at the drive through.  She has to come in and be counseled.  I will do it all, including the cashiering.”

I got the distinct impression that the technician was a bit put out, but tough shit.  I don’t mean to offend, but if that happens, the technician has a grandiose self image and that needs t o be squashed.

I have written about the value of Pharmacy Technicians many times.  (Here and in Drug Topics) I believe that we cannot do without them.  They are not paid enough.  Period!

Counseling on “The Morning After Pill” is a no-brainer.  You confirm that it has been within 72 hours of the event.   You tell her to take with food to prevent nausea and vomiting.  It is a hormone, after all.  If she vomits in the first three hours after the taking the dose, she has wasted $44.99.  She has to come back and buy another box.  I make sure that she knows that her breasts may become tender.   It is a hormone.  I tell her that her period may come early or late.  It is a hormone and hormones are the directors of the symphony.  I ask if she has any questions.  Then I take her money.  (If the young man who enjoyed her impetuousness and lust does the paying, he is a very cool guy).

Now, this is going to get fun, you guys, watch the comments.  In the past, I have “Punched My Ticket To Hell”.  I Have been accused of being an atheist .  I am not, by the way.  My spirituality is my business, but it does not include Yahweh, Jehovah or God.  I do not believe in the divinity of Jesus Christ or Mohamed.  I was raised as a Christian in time when most communities were Christian.  So, I quite naturally am guided by the rules, proscriptions and generosities of the way I was raised.  That being said, I assure the young woman buying the Plan B, “THIS IS NOT ABORTION”. For some girls, this is a relief.  Others, it is Ho Hum.

Later, when we were not busy, I said, “About the Plan B”.  I made eye contact.  ”You do not need to take that kind of liability.”

“How so?”  (meaning what liability?)

“How did you tell her to take the second pill?”

Oh oh.  I could see the wheels turning.  Is this a trick question.  ”Tomorrow.”

“No.”  I let it linger like a turd in the punch bowl.  ”Twelve hours.  Whose ass goes down if she gets pregnant after not taking the pills properly.”

The eyes showed fear, danger, embarrassment.  ”Mine.”

Yeah, I thought, but did not say, No, it would be my ass.

“You do not need that kind of liability,” I repeated.  ”If the other pharmacists ask you to sell this, I recommend that you zip your lips and tell them to read the box.  Nothing more.  If she has questions, you call the pharmacist.

Think about it.  Your professional life depends on your acting like a professional.  If you think your job is minding “The Mill” and doing none of the “distractions” that federal and state pharmacy laws regulate, expect your wage to eventually be reduced to 60% to 80% of what it is now.  Tell your husband that the BMW that he has been dreaming about may not fit in the new budget.  That timeshare in Cancun.  Sell it when you can get a good price.  The golf membership?  That’s big money that is the 40% to 20% that your non-professional behavior will lose.

The private school for your kids?  Keep it.  Your children must have a good education to survive in 21st Century America.  But, Jay Pee.  How can we afford it? By giving up some stuff.

The best way to get a professional wage is to act like a professional.  If you get push back from your metrics-obsessed company, document everything and take our friend Pharmacist Steve’s advice .  Send emails asking for clarification.  Ask where you can find guidance in the company’s published Policies and Procedures.  Always, as Steve advises, copies of everything goes to the company’s Chief Compliance Officer.

Pharmacist Steve is the National Public Relations Director for The Pharmacy Alliance.  I will suggest to Steve that he writes a manual on how to do this.  Steve is a very bright guy who has been around the race track a few times.  It is guys like Steve who can help us get our feet  firmly back in control of this game.

Express Scripts CEO’s remarks draw fire

NEW YORK – A less-than-flattering assessment of pharmacists from Express Scripts Inc. chief executive officer George Paz has fanned the flames over his company’s proposed merger with Medco Health Solutions Inc.

Paz, who is the company’s chairman and president as well as CEO, remarked during Express Scripts’ fourth quarter conference call, “Nexium is Nexium, Lipitor is Lipitor, drugs are drugs, and it shouldn’t matter that much who’s counting to 30.”

Paz also said patients generally are able to change from one retail pharmacy provider to another with little or no ­disruption.

Steve Anderson, president and CEO of the National Association of Chain Drug Stores, noted that Paz and Medco CEO David Snow told Congress in recent hearings that they like pharmacists. “Their comments about pharmacists in other settings may not rise to contempt of Congress, but they certainly meet the standard for contempt of patient care,” said Anderson.

He added that Paz’s comment “rivals the insensitivity toward patients and pharmacists” shown by Snow with his “now infamous ‘robots versus pharmacists’ comment.” (Snow said in October that Medco’s robots are “23 times more accurate” than human pharmacists.)

Think about this.   The implication is that we do not provide cognitive services so they won’t pay.  Logically, if we DO provide cognitive services, they have to pay.  They have set themselves up.  A good attorney could make them squirm.  You know my thoughts.  We lose if you do not start counseling.  Why would they want to pay you six figures for minding “The Mill”?

Medco CEO David Snow said at a Cleveland Clinic healthcare conference in October 2011, as quoted by Pharmaceutical Executive magazine: “I’m not dissing retail [pharmacy], but there’s a fiction that a pharmacist comes out and dialogues with you. In reality, a high school student hands you a script from the shelf.” He also said that Medco’s “robots” are “twenty-three times more accurate” than human pharmacists

Senators ask about Rite Aid’s ‘wellness ambassador’

NEW YORK – Addressing concerns expressed by two U.S. senators, Rite Aid Corp. has clarified the role of its “wellness ambassadors,” a key feature of the drug chain’s new “wellness store” format.

In press announcements late last week, Sens. Richard Durbin (D., Ill.) and Richard Blumental (D., Conn.) questioned if Rite Aid was confusing customers with the wellness ambassadors. The senators said customers might mistake the ambassadors — who wear white coats — for a pharmacist and wondered if the ambassadors were making product recommendations or providing health advice or product information for which they lacked sufficient knowledge or training.

The Camp Hill, Pa.-based drug store chain, however, said the function of the ambassadors is presented clearly to customers and the ambassadors aren’t portrayed as health care professionals.

This was in “Chain Drug Review”.  Who are these smiling young women wearing white coats.  Technicians?  I don’t think so.  They are NOT pharmacists. Do you see what I see?  These “Wellness Ambassadors” are going to be giving OTC advice.  I will not allow my techs to do that.  These babes will be illegally making claims about supplements.  ”Oh yes, ma’am.  You won’t be fat anymore if you buy this $60.00 a month GNC product that has as its active ingredient something called ephedra equistina.

Rite-Aid is engaging in dangerous practices.  What Big Stupid does can affect the entire industry.   The CEO at Rite-Aid is a grocery store man.  He has no standing in the pharmacy industry. If you have never been in the water, you will never swim.  The Rite-Aid MBA Masters of the Universe who came up with this any-girl-in-a-white-coat “Ambassador” Bullshit again make pharmacy look like crap.

You know that your wife’s elderly Aunt Sally is going to the accessible “Ambassador” when she has questions.  The RAD pharmacist is too damn busy cranking The Prescription Mill to talk to Sally.  The pharmacist never knows that Sally has a question.

This is a serious professional problem and the “Profession” needs to make a statement.  Where should that come from?  The APhA.  Yeah, I know, you are laughing so hard you gave yourself a hernia.

I do not want to put the onus on the RAD pharmacists in stores where the “Wellness Ambassador” program is in effect, but I have to.  The minute you see Rose Ann giving professional advice, you gotta stand up and say something.

Our friend “PharmacistSteve” has a good handle on on to communicate appropriately and cover your own ass in the process.  Steve, will you take a minute to give an outline please.

By the way, this program is transparent.  Big Stupid’s desperation is dripping all over it.  They are trying to mimic the program that WAG is instituting.  WAG puts pharmacists out front.

 

The comments have turned this “Power” essay down an interesting path.  There are been numerous inquiries recently asking Where Is The Pharmacist/Pharmacy Lobby?  I’ll expand If the AMAis the medical doctors’ lobby, what happened with APhA?  I do not believe that the APhA has been a proponent for pharmacy since William Apple retired.  He was a vibrant leader.  He proposed a “Behind the Counter” Class of drugs 25 years ago. A BTC Class would cement our pofessionalism, enhance our visibility, take us back to the profitable “Counter-Prescribing” model.  The doctors’ lobby, the AMA, fought it like a bull dog.  The AMA accused us of wanting to practice medicine.  Protect their turf even if the patient is harmed.  Monistat (my poster child for a dangerous OTC) can be sold at truck stops.  When Aunt Sally’s cousin’s sister diagnoses a bacterial vaginosis as “yeast” and Hannah’s second daughter Brenda ends up with PID and forever unable to have children, how patient-centric was the AMA?  We do need a strong lobby.  The APhA should be it.  3-12-2012

This is most likely a bore to you.  A ho hum.  A “What else is new. Plagakis?”  I have have harped on this many times right here at Pharmacy.Jim Plagakis.Pharmacist and in the books I have written and I can’t help but wonder, “Are these people blind or are they so institutionalized that they are constitutionally unable to see what is the truth?”  Your life will be better if you just step aside for a moment and take a good look at what really counts, the laws and rules that govern the practice of pharmacy.

There are laws in all 50 states that make you the “captain of the ship, the driver of the train” no matter what the establishment does to attempt to get you to believe otherwise.  They can’t even unlock the door without a pharmacist present.  You have to be there when a prescription is dispensed (sold).  You legally should be available and willing to counsel, but I know that most of you are not there yet. 

The non-pharmacist manager is a non-starter.  Pharmacy law wins the day when there is a conflict between the law and company rules.  Period! There is no compromise, no wiggle room for the company.   The non-pharmacist manager doesn’t even get to come into the pharmacy without your permission.  The company that I work for now, part time, seems to understand that.  When I first started working at this store, I was pleasantly surprised when I made a comment about a malingering technician to the store manager, he told me that I had to talk to the pharmacy manager.  On more than one occasion, when I had disputes with “customers”, the non-pharmacist manager had my back.  Last summer, a very loud customer was demanding that I call her father’s doctor for a prescription that he had promised to e-prescribe.  For reasons that you understand, I refused.  A call would have unnecessarily interrupted our work flow at 6:00 PM on Friday evening.  This woman was more invested in getting me to bend to her will than in getting her father’s prescription.  It was not going to happen.  I dialed the Access Center at UTMB.  When it started to ring, I handed her the phone.

“What’s this for?”

“When you get your father’s doctor on the line, call me over.”

Arrrrrrgh.  It was as if I had handed her a hot iron.  She actually dropped the phone on the floor.  Her eyes widened, her nostrils flared, her face flushed, her nose was running.  “Are you trying to be smart with me?”

We had an audience of waiting patients.  As a group, they laughed.  One woman applauded and a rough-looking guy who works off-shore on an oil-drilling rig,  said directly to the woman.  “Let him do his job, lady.  We have all been waiting our turn.  What makes you special?”

“I am going back to work,” I said calmly.  “When your father’s prescription shows up on the e-prescription queue, the technician will enter it and I will get it ready as fast as I can.  It will get the same attention that I give to all prescriptions.  Your father will get the right drug in the correct dose.  The label will have the appropriate instructions and I will make sure that you know if there are and dangers associated with the drug.”

She went ape-shit, but I was not going to give her any more attention.

A few minutes later, she returned with the non-pharmacist manager in tow.  “He was rude,” she said.  (Have you ever noticed hate you are RUDE if you do not or cannot give them wha they want?)

My champion from the oil rig  said, “Come on, lady.  If anyone was rude, it was you.”  There was a general rumble of agreement from the audience.

“He refuses to call my father’s doctor.  He is the pharmacist.  That’s his job.  Make him do it.”  Picture a woman on speed.  She may or  may not have been chemically enhanced, but she was a picture of a menopausal syndrome out of control.  She was obviously a smart rat.  In her mind, the pharmacist is merely a clerk and that is a role we MUST refuse to take.

This was the quintessential example of a company playing the game correctly.  I was a bit surprised that the manager did not even ask me any questions.   He said to her, “He is the pharmacist on duty, Ma’am.  He runs the pharmacy.  I am not his boss.  I can’t make him do anything.”

The Kelly Hoots embarrassment in North Carolina has still not been judged by the North Carolina state board as far as I know. It has taken too long.  The board is in a difficult situation.  North Carolina has a 12 hour rule.  No pharmacist shifts longer than 12.  We all know that a CVS shift is traditionally 14 hours.   That is for starters.  A CVS non-pharmacist store manager illegally usurped the legal authority of the Pharmacy Manager.   North Carolina law clearly stipulates that the pharmacist is the authority in the pharmacy- PERIOD.  It also states that the pharmacist is legally required to make sure that everything is done in compliance to the law and that includes making sure that patient safety is the paramount concern.

Mister Hoots was working without a competent technician.  He was behind.  They were putting out one prescription every 80 seconds.  Maintaining a safe work flow was damn near impossible.   Mister Hoots closed the Drive Through.  The Non-Pharmacist Store Manager stormed into the pharmacy and opened the Drive Through.  Kelly Hoots closed the pharmacy and went home, an expression of his frustration.  He lost his job. 

The Kelly Hoots case could be a Poster Child for pharmacy.  I have not checked recently, but I think it is time to re-visit this drama and see how it is coming.  The point is that CVS thinks that company rules supersede the law.  I don’t think so.  If the North Carolina BOP is to maintain its integrity, they will have to cite and discipline CVS.

This has gotten away from me.  My original purpose here was to comment on two dynamics at play in retail pharmacy.  The Prescription Mill which has nothing to do with practicing pharmacy and the actual practice of pharmacy.

The Prescription Mill is a bean-counting process that can be done by a well-trained technician.  That is going to happen and I believe sooner than later. 

The practice of pharmacy is what will define us in the 21st Century.  The problem is that most of us do not do it consistently.  This is a problem.  How do you fix this?  How can we tolerate a pharmacist like Kelly Hoots being fired because he insisted on creating conditions where he could comply with the law and practice pharmacy under the worst of circumstances?  It is unconscionable to think that the 350 pharmacists who visit here today will all blow Kelly off.  At the very least, a polite inquiry made to the North Carolina BOP would make a difference.  They would know that SOMEONE IS WATCHING.

You have enormous power.  The laws all are aligned with our purposes of providing safe pharmacy services.  We just have to insist that the laws be enforced.

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The Amity/Enmity Complex is a social phenomenon that happens between individuals, clubs, and companies in an industry or countries.  Essentially, it comes down to “We have the same enemy, so we are friends”.
The best example of the Amity/Enmity Complex is the state of Israel.  There is no more argumentative social group of people than Israelis.  It seems that disagreement and debate is part of their national endowment.  Individual Israelis   will argue about anything.
The danger that Iran represents is not open to argument.  All aspects of society in Israel agree that we do not argue about Iran. Israel is totally aligned against Iran and the danger to Israel that its nuclear program represents.
The Amity/Enmity Complex is beginning to form in the pharmacy industry.  Walgreens has refused to execute a contract with Express Scripts because the reimbursement rates in the contract would result in Walgreens losing money.
In the beginning, the industry looked on with interest.  Some people said, “Walgreens is stepping out of its comfort zone”.  Some companies gleefully advertised “Bring your Walgreens Express Script Prescriptions to us.”   A profession would sit back and let it play out naturally.   Can you imagine a doctor advertising “Doctor Smith no longer takes Medicare Patients.  Call and make an appointment with Doctor Jones today.  Medicare accepted”.
Companies like Rite-Aid are just vultures.  But, Walgreens has shown that it is not a carcass.  This drama is playing out satisfactorily.
Frederick Mayer, RPh, MPH is the Founder and President of Pharmacists Planning Service.  Mister Mayer has been a practicing pharmacist for over 50 years.  He opened his Sausalito, California pharmacy in 1962.  Fred has been an outspoken commentator on pharmacy issues for decades.  What he has to say is listened to carefully.  Drug Topics published a major commentary written by Mister Mayer in the February, 2012 “Final Word” feature.  He titled his column: “Walgreens Draws a line in the sand”.  It is a terrific article.  It is interesting and presents data and information that we all should know.
More important, the essay indicates that the Amity/Enmity Complex is beginning to play out.  Express Scripts is not only the enemy of Walgreens.  ESI is the enemy of every pharmacy, large or small, and every pharmacist.
ESI has overreached.  By extension, all PBMs are the enemy.  Pharmacists are no longer wringing their hands.  They are no longer effete and powerless.  They can do something.
Pharmacists United for Truth and Transparency has made major statements that indicate that the organization fully supports Walgreens.
The PBM industry, a for profit engine, has driven countless independent pharmacies out of business.  Average Americans are pulling together and expressing that they object to mandatory mail order.  In Georgia, the voters overwhelmingly chose to ban mandatory mail order.
There is something happening here.  I believe that the Amity/Enmity Complex is at play.  Not that long ago, Walgreens was considered to be an enemy simply because it is so huge.  Not any longer.
The PBM industry is everybody’s enemy and the energies are being focused on taking control away from them.  The PBMs deny coverage.  They fight to NOT pay for expensive drugs and they have been getting away with it.  The reimbursements are ridiculous.  They confidently bully the entire medical care industry.
When doctors realize that they and pharmacists are enemies of the PBMs it is going to get really interesting.  Doctors and pharmacists pulling together.
The Amity/Enmity Complex is beginning to coalesce.  “Your enemy is my enemy and we can be friends and work together against that enemy.”
Again, I am confident that our friend Pharmacist Steve will outline an effective strategy on how to fight that enemy.

BIG EVIL

How can CVS-Caremark continue to get away with business plans such as this?  How can our profession tolerate this kind of criminal activity by a company that represents a huge percentage of our industry.  How can the powers to be in pharmacy continue to look the other way.  How can they see this huge “Turd in Our Punchbowl” and pretend that it is not there?  It is time for official condemnation.

This story also involves the Cardinal Health Distribution Center in Lakeland, Florida.

Wednesday, February 29th, US District Judge Reggie Walton in Washington essentially closed this distribution center down.  The Cardinal Health facility in Lakeland is now blocked from shipping Controlled Substances.  Any and all Controlled Substances.

Two CVS Pharmacies in Sanford, Florida, a town of 53,000 about 30 miles south of Orlando, had their registrations suspended.

These actions were the up-to-date result of months of investigation by the DEA.  On February 7th, CVS-Caremark sought and were granted a restraining order to allow the two stores to continue with business as usual.

Let us focus on one CVS store in Sanford.  The 24 hour CVS #219.  Cardinal health shipped 2,050,000 (That’s Two frikkin’ Million plus) tablets of oxycodone products to Store #219 in 2010.

Let’s speculate that each Rx for oxycodone products were for one hundred tablets.  That comes out to 20,500 prescriptions for oxycodone products in 2010.  That is 57 prescriptions per day.

What the?  How is it possible that the Pharmacy District Manager did not notice this huge amount of a highly desirable drug to drug seekers?  I trust that plenty of these doses were OxyContin.  How could the Pharmacy District Manager did not see the red flag of huge dollar amount invoices that were being received weekly or even daily?  What about his boss, and his boss?  What about the people with authority in Rhode Island?  There must be a culture of silence.  Can you imagine what would happen at Wal-Mart or Safeway or Walgreens, even Rite-Aid?  The Pharmacy Manager would lose his job in a Arkansas minute.

What disturbs me the most is that this post may just be the only place in pharmacy journalism where this story is heard.  I trust that Drug Topics will say something because I sent the story to the editor this morning.

The two CVS stores in Sanford are essentially out of business.  If I read the story correctly, the judge agreed that the DEA has established “imminent danger to public health” and it is necessary to suspend the pharmacies’ registrations.

CVS has said that it will suffer irreparable harm if forced to stop filling prescriptions at the two Sanford CVS Pharmacies.  Well, what the hell, CVS.  Do you expect the judge to look the other way?  That is what the state board do.  This is a Federal Judge.  How embarrassed is the state of Florida and the BOP?

I say, “Good Riddance”.

I am very interested in how CVS Pharmacists feel about this story.  It has got to cause your stomach to flip flop and your heart to hurt.  Your personal professional standards are trampled daily. In the end, we are all responsible for the professionalism in pharmacy.  This kind of shit is equivalent to a bar in the seedy part of town selling ten dollar well drinks when the strippers are on stage.

My recommendation to all CVS pharmacists is: Cover your ass. Document everything that is shady or even two degrees from ethical behavior.  Dates, names, what happened, who said what.

I trust that our friend Pharmacist Steve will have detailed advice.  He has a better handle on what to document and where to send e-mails than any other visitor to this site.

I hate this shit.  This is not how our profession should be conducted.  I am an idealist.  Why not?  I am not about to compromise and I certainly will not make excuses for Big Evil.

How can we stop this loose cannon company?