Pfizer is the BP of Drug Companies

The DRUG PRICE COMPETITION AND PATENT TERM RESTORATION ACT of 1984

This act made it easier for generics to enter the market.  It allows for manufacturers to extend the patents on brand name products.  The act was also designed to promote and influence the development of drugs that are really new.

What the……?   Where are they?

The new drugs are profit-makers that cost over $1,000.00 a month, are IVs and the guy talking really fast in the television commercials reminds you that the patient can suffer instant death at any time.

Esomeprazole, escitalopram and desvenlafaxine ARE NOT NEW DRUGS.  But, they got a new patent.

When the guardians of the public come up with a new law that benefits a business a company does have some responsibility, don’t you think?  Where are the new $100.00 a month PO drugs that your average American can get at the pharmacy?

They improved on lovastatin.  They ran the course from hydralazine to the Angiotensin II receptor blockers and no American needs to sit and wait for a stroke.

You would expect that they would double down on Type II diabetes because it is estimated that one in every three Americans will be “afflicted” because of all of the french fry gobbling, burger chomping fatsos.  But, they really haven’t.  Can you imagine that it might be more profitable to simply manage diabetes than working toward curing it? Not enough profit in curing anything.

I am cynical and you know Jay Pee, I am an optimistic idiot.  But, I have no faith in Pharma, big or small.  In the 21st Century, it is all about GREED.  I firmly believe that curing illness is not a priority.  If the people are cured, they will not need that $1,000.00 a month drug.

So, Big Pharma got patent extension in return from allowing the generic manufacturers to use (basically) their package inserts.  It’s a no brainer.  The proof is in the pudding because in 1984, Big Pharma made promises about innovation.  Big Pharma has not kept faith with the American people.

You know that I have been around for awhile and I clearly remember when there were NEW drugs every year.  Not anymore.

Pharmacists have gone from being the drivers of the profession to being prescription-drug pimps.  Period.  How did this happen?  My contention is that it happened as the industry became became more invested in profit and less invested in healing, curing or ameliorating disease.  To the contrary.  More disease.  More profit.  Period.

What do we do?  What can we do?  Take the enormous profits for drugs like esomeprazole off the table, that’s what.  Make innovative drugs where the money can be made.   Force them to come up with molecules that are actually NEW.

I get a hernia, I laugh so hard.  The Jay Pee, Patient, Pharmacist lobby has no power.

Before you read this, relax.  Rita Hayworth.  From the golden age.  I read the Frank Langella piece in Newsweek last month.  Rita had Alzheimer’s near the end.

What an idiot.  I have been the naive turtle.  I actually believed that the pharmacy boards had the welfare of the public as their sole mandate.  Then, I heard that the Texas Board has stated, “We don’t interfere with in how a company does business”.

The preliminary hearing conducted by the North Carolina Board of Pharmacy in May will tell us a lot.  The NCBOP members are all working pharmacists (+public).  No chain store executives.  We’ll be watching.

Perhaps, we should just give up and go directly to the legislatures and the media.  Find a young state legislator (certainly moderate, liberal or progressive) who wants to make his/her bones and give him this.  It could prove to be a “hot button” issue.  What do you think.  I gotta go.  Duties with the wife call.  I’ll be back.

Five Weeks?

There will be “Tech Check Tech” and I think it will be sooner than later.  We cannot continue to define our jobs as what we do to run “The Prescription Mill” and still call pharmacy a profession. A this stage, we are presiding over a professional failure.

I testified at a meeting of The California Board of Pharmacy in August of 1972.  The California board rotated the cities where they held the meetings.  This one was in San Francisco.  The number one issue that had gathered a list of maybe 15 people who wanted to testify was: Shall a new designation of pharmacy ancillary help called “Pharmacy Technician” be allowed.

People went ape-shit.  The unions were there.  The Guild was there.  The associations were there.  All of these people defined pharmacists as “Prescription Mill” minders and that was what we did in 1972. They warned that pharmacists would be out of jobs if technicians were allowed to type prescription labels.  They screamed that patients would be put in danger.  They all were smug and self important and then Jay Pee stepped up to the microphone.  If the union chiefs had tomatoes, they would have been flinging them.  The head of The Guild shook his fist at me.

My message to the board was simple, “We do this or we are dead as a profession”.  You know how that turned out.  Without technicians, we would be dead in the water.  We would not be able to provide essential medicines to all patients in an effective, efficient and timely manner.  We would be a failed profession.

We cannot afford that.  When there is “Tech check Tech”, you can go do what pharmacists at mandated by law to do.  I do not have to remind you of what that is because you break the law 100 times a day.

“But, Jay Pee, how can you trust technicians to deal with interactions, dosage irregularities and those types of incidences?”  You don’t.  That would be idiotic.  When the pharmacy software stops the process and warns:  Look at this.  Only a pharmacist can look at it and sign off.  I think you do that with a secret password.  In Washington state, my password was:  JPOK.

For “Tech Check Tech” to work, we need a new designation.  I suggest “Advanced Pharmacy Technician”.  They must be trained by the industry and not by the companies. I do not believe that all drug store/ big box/ grocery companies can be trusted.  Rite-Aid will do anything to try to get a profit.   CVS has a reputation of cheating.  Just Google CVS in trouble. The list is huge.   The APhA loves this kind of shit.  Let them do it.  I have no doubt that an Advanced Pharmacy Technician designation earned by working through an APhA program would produce the real deal.

Celebrate.  What do you do?

You counsel.  You explain to the young mother with a 4 year old asthmatic child how to use the Xopenex MDI with a spacer.  In the process, you discover that the young mother is illiterate and she cannot read the dosage instructions on the tapered dose of prednisolone liquid.  You go and be a professional.

I do not expect that this process will be slick and easy.  It will be new.  I can attest to the value of counseling, on Rx, on OTC drugs, on wound care.  People like it.

There are pharmacists who will not want to do this.  Go into real estate.

There are pharmacists who will not be competent.  Now, that is scary.  Should the pharmacists who give inaccurate counseling advice or incomplete counseling advice continue to get a six figure salary?

This is coming, you guys.  Better get ready now because we want to run this ship.  We do not need non-pharmacist MBA Masters of the Universe anywhere in the process.

And that Problem Is:

The Merger Has Been Approved.

I am taking a five day vacation.  Be back the 11th.  If it rains, I might write something here.  In the meantime, what are your thoughts?

Every day, I hear from pharmacists who have been working in conditions that put the public in danger.  From everywhere, almost.  I have never heard from an Oklahoma pharmacist.  Does that mean that it is different there?

You are not getting enough help because your company is not making enough money.  It is not your fault, but the result is that your department is a hard slog every single day.  You violate the law.  You give no shit about patient care.  Wait times rule your kingdom.  This is not practicing pharmacy.  This is a rodent on a hamster wheel.  The “Prescription Mill” needs Advanced Technicians, but we need strong advocacy from You Know Who.  It starts with an  ”A”, ends with an “A” and had “Ph” in the middle.  That gripping you feel in your stomach is not good for your health.

Here are my thoughts.  The big companies that run pharmacies aren’t making adequate profits and it is their own damn fault.

Forty years ago, 90% of all prescriptions were cash.  There were no on-line plans.  Paid and PCS were paper billing. The union members brought in cards that the “Pharmacy Clerk” (There were no techs yet) filled and the RPh signed.  The patient paid cash and was reimbursed by the union’s welfare/medical fund.

Some bright idiot Master of the Universe (probably a 1970s version of a graduate of a night school MBA program) said, “Hey, you guys, we can get a competitive advantage by lowering our price on the top 50 prescription drugs.”

“Awright,” the CEO chortled, “Let’s do it.  We don’t need that 40% profit.  We can get by with less.  Light up the big cigars and pop the corks, Motherfuckers, let’s do it.”

Down the street, the Masters of the Universe at Drug Chain Lemmings responded, “We’ll show them. Let’s do the top 75 drugs and go lower.”

After every drug store chain lowered their prices, NOBODY had a competitive advantage.

But that paradigm has driven the algorithm of our industry since the 1970s.  What really pisses me off is that non-pharmacists (I love to call them Masters of the Universe) have ruined our industry and nobody seems to notice.  I would have fired their asses with the first utterance of “Gift Cards”.  Let them go ruin a big box store or a grocery chain.

MBA Mastesr of the Universe have traditionally been viewed as shady characters unless they graduated from schools like The Wharton School and, trust me, MBAs from U Penn, Stanford or Yale are not working for Rite-Aid or CVS.

Doesn’t it piss you off that your industry has been ruined by kids who HAVE NO STANDING?  None of them have ever answered a pharmacy phone.  None of them have ever ran the POS.   None of them have ever gone to the drive-through and had to breath exhaust from a 1978 Pontiac.  And those are just essential tech jobs.  You could not even start to explain to them what a pharmacist does (and is supposed to do).

“I know Mr. Master, that I should be doing all of those “Waiters” on the counter, but this young woman is bleeding all over your new waiting area furniture and I am going to put her Methergine prescription first.

“What about Mister Tantarino?  You want me to do his Norco, Soma and Xanax first?”

“I am going to ignore that mouthy bastard who keeps whining that he ‘Needs his meds now’.”

“What’s that?  I need to follow company policy?”

“You need to kiss my ass.  I think I will call the state board of pharmacy on your ass.” (You and I know what a joke that would be even if I officially complained of non-pharmacist interference.) But the MBA does not know that.

Silence.

“Hey. Mister Master of the Universe, what’s your home address?”

“What?  Why do I need your home address?  Because I am going to send my tech “Bruno” over to kick your fuckin’ ass after he breaks your kneecaps.”

Sorry about the adult language, but, my friends, I need that kind of release once in awhile.  The language does not diminish the message.   The only mistake we made was to allow this to happen…. for a paycheck.

In the mid-1960s, an outfit called Revco started the deep-discount madness in Ohio.  The big question being asked at the University of Toledo was, “Would you work for Revco?”  Most of us said “No”, but some of us did go to work for Revco.  We could have killed off the discount craziness fifty years ago.

I have talked about the coming avalanche of prescriptions.  One statistic.  10,000 Americans turn 65 every single day.  That’s a lot of prescriptions.  If you are youngish, look into an SBA loan and open your own store.  If you like rural areas, you cannot miss.