Hey Jim, What is the pharmacist glut looking like and how do you think it will develop with added rxs from baby boomers, added rxs from healthcare reform, and loss of Pharmacists due to boomers retiring? I offered to take a wage cut at my independent because I want job security. Are wages falling? for pharmacists?
PLEASE ANSWER

I don’t know.  I never “know”, but, because I write JP at Large, I have been “watching not just looking” and “hearing not just listening” for 25 years.  First, read my column in the July, 2012 Drug Topics.  There is a link here. If you haven’t, you can subscribe to the digital edition of the magazine.  Very cool, delivered right to your e-mail in-box.

It looks to me that there is now two categories of pharmacists.  ”Pharmacist Merchants” who know how to run the business (both PIC and Staff) and “Dispensing Robots”.  The companies that gleefully go after the “Robots” will lose in the end because the companies that see the value of good “Merchant Pharmacists” will cream them.  Be a good “Merchant Pharmacist”

When Americans go to the doctor, they think they are getting cheated if they leave without one or more prescriptions.  The implications.. Again read my July column.

The avalanche of prescriptions coming.  You ain’t seen anything yet.  10,000 Americans turn 65 every single day.  We won’t even hit the peak until 2023.   You think that Pharma has developed expensive drugs for mature people now.  Watch what happens in the next 25 years.

No, wages aren’t falling.  If they try that, they are doomed to only employing the “Dispensing Robots”.

Please don’t worry.  You are a good pharmacist.  You went to U Dub.  A great school that actually has good old-fashioned compounding labs.  You will always have a job.  Your choice of places to live may restrict your job opportunities, but that is a lifestyle choice, not a job choice.

PS: How can we, as a profession, allow people who cannot compound, who went to schools that do not teach compounding, to call themselves “Pharmacists”.  Compounding is our quintessential skill.  No one else can do it.  It is worth big money.   This is an ongoing mystery.

Larry Merlo, RPh, CEO of CVS.  Notice that it doesn’t say College of Pharmacy behind him.  A business school.  I absolutely have no respect for the non-pharmacist bean-counting numbers crunching MBA Masters of the Universe that have ruined the business of pharmacy.  We need to send them to the variety store where they belong.  Get their asses out of the pharmacy.

I receive messages from pharmacists, almost daily.  They talk about their life at work.  Too often they are about CVS, “Big Evil”.  Here is another one.  I also get plenty of questions from pharmacists asking,  ”Why don’t you ever talk about Walgreens.  There are the biggest chain.  I heard that they are horrible.  I would never work for Walgreens.”  They reason I do not pass on incriminating accusations about Walgreens is because there aren’t any.  I get very few e-mails complaining about Walgreens.  The ratio CVS:Walgreens is about 100:1.  A couple months ago, a Walgreens pharmacist and shareholder wrote a public letter to Greg Wasson, RPh,  the CEO of Walgreens.  She lambasted him.  She called for his resignation.   You can scroll down and find it.  This pharmacist was righteously pissed off.  The Ratio CVS:Rite-Aid is about 20:1.  The RAD share price, as I write this, is  $1.16.  How much can I write about “Big Stupid”.  The RAD CEO is a grocer.  If Rite-Aid pharmacists want to give me a fresh view, I’ll put it up.  I’d like to know how the non-pharmacist, non-tech “Wellness Ambassadors” in white coats have worked out.  Yes, the same program that caused the United States Senate to hold a hearing to ask RAD executives, “How do you let customers know that this ill-trained ambassador is not a pharmacist?” What a frikkin’ embarrassment to our profession.  CVS cheats and Rite-Aid stumbles along, one missed payroll or one missed Cardinal payment to lights out.

After more than 20 years of having the Tail Wag The Dog, finally, The Dog Wagged The Tail.  I trust that the new agreement that Walgreens negotiated with ESI is satisfactory to the country’s largest pharmacy retailer.  7600+ pharmacies.  Probably more than 20,000 pharmacists are affected.

In the beginning, the dog wagged the tail.  We were not convinced that PBMs would benefit pharmacy.  We did not want to wait for our money.  In the late 1960s, there were two companies that administered prescription claims.  PCS and PAID Prescriptions.  We filled out forms in triplicate, mailed the bottom two copies and got our money a few weeks later.  The patient paid the copay at the time of service.  We relented and the industry went along with this idea because the money was very good.  We were paid FULL 100% AWP + $3.60.  This was in frikkin’ 1969.  The pharmacy industry was a big dog and the tail was a stubby little thing.

Fast forward.  What kind of gross profit do we get on a net cost $100.00 Rx?  What the hell happened?  Could it be that smart, good merchant pharmacists working for the chains were told to go stay in the pharmacy and behave?  Were we told to not make waves?  I know that we were told by smug MBA-types, “It is going to be okay.  We know what we are doing.”  They came in not knowing a thing and they fucked up our industry all by themselves.  As the slide accelerated, they ran faster, chasing each other.

Walgreens got a multi-year contract with ExpressScripts.   Way to go.  Some football guy (Vince Lombardi?) said, “When the going gets tough the tough get going?”.

It is now time for the Poodle Dogs to get it going.  CVS has their own tail.  Rite-Aid is in such a downward spiral that it is chasing its own tail.  There has to be somebody else out there who is willing to “Wag the Tail”.  Otherwise the Tail will keep on Wagging the dog.  Step up Poodle Dogs, let’s see what you got.  Taking a good look, I’d say that you have some snap, especially if you get cornered.

I found this in my Facebook messages.   It was dated August, 2011.  I rarely check those Facebook messages.

It is not possible to not have noticed the “new” pharmacy schools.  They are clearly for-profit.  Some of them offer an accelerated program.  Some of these kids come out with no clue of  what you use a mortar & pestle for.  I watched a kid who was floating for a day look at an Rx that would require compounding.  A simple three ingredient cream.  His problem is that he did not know what aa qs ad meant.  I have little experience with these “new” pharmacy schools.  I have done no research.  Help us out here.  Tell us what you know.  By the way, I know nothing about the Feik School of Pharmacy.  It may or may not be “new”.  I had never heard of  it.  I found the images and the name of the school indicates that it is parochial.  If you have a better example, tell me.  I will replace the images.

Give me more you guys.  Make it your mission to help us “out” these schools.  The industry needs “Pharmacy Merchants”.  We are in a “business”, like it or not.  These “Dispensing Robots” cheapen pharmacy.  My friend Davey just graduated.  He has plenty of experience interning with WAG.  He is a pharmacy merchant.  Put him beside a robot and the choice is easy.  I will publish a list right here.  Name of school.  Annual cost.  Tuition, books, room, board and miscellaneous.   Important if they are a less than 6 year school.  Fuck it, man. Compounding is the quintessential skill of pharmacists.  It is a lucrative skill and will get better.  We cannot tolerate people who cannot compound calling themselves pharmacists.  Period.  At the very least, a pharmacist must be able to do a “Cancer Cocktail” and figure out how much of a 12% and how much of a 6% do you use to make 60 Gm of a 9%.

Jay Pee 8:00 PM, 7/21-12

The message from Facebook

With all these for profit right wing religious “pharmacy” schools here in the South (most unprogressive anti-worker but self proclaimed Moral hypocrites place I have ever been) are pumping out corporate dispensing bots, what is going to become of pharmacists? ………Is the aging of the population and expansion of benefits to the working poor (thru healthcare reform) going to absorb these lower academically able corporate tools? Am I negative today. Problem is I know some of these pro-corporate, anti-worker future pharmacists and their “religious” backgrounds for despising all but the wealthy and successful. Got cancer. It is your own fault.

Subject: Walmart terminating pharmacists in recovery.
Date: Wed, 18 Jul 2012 08:33:47 -0400
From: Rick@beliveau-fradette.com
To: jpgakis@hotmail.com

Now, that is money.  Express Script Profits for 2011.  Ready to be sent to The Caymans

Here you go.  THE VAMPIRE SQUID.

The Vampire Squid are the PBMs.  They are the tail that wags the dog.  It is our own fault.  As in other areas, we allowed non-pharmacists the nelm for the ship.

PBMs were not in existence 20 years ago.  They saw an opportunity and they pounced.  They went to the big insurers and said, “Hey, we can save you money.  Let us administer your prescription benefits.  We can save you money.

What they did not say is: “The way we will save you money is by ripping the skin off the pharmacists’ backs.”

PBMs provide NO medical care.

They are just specialized BIG BANKS.  They have insinuated themselves into the “Cash Cow” Industry.  It ain’t ours anymore.  It is theirs.

PBMs are for-profit engines.

Okay, let’s see if this one has legs.  I have to go.  V and I are getting prepared for our drive back to Galveston.

Let’s see what you think.   I’ll add to this later.

Comment on IT IS OUR OWN FAUL

7/16/2012 Found this in “Comments”.  Too good to leave there.

From Greg Alston

13 Stories is not enough.  We want to publish something that we can send to the boards, legislators, the media.  We need racier stories.  Scarier stories.  You can be anonymous.  Give it up.

Tired is dangerous.  Exhausted can be catastrophic.  Dispensing errors are made every single day.  Thousands of them.  Many cause harm.  Some cause death.  Most of them, nobody ever knows about, not even the pharmacist who made the error.  The person dies.  Her sister’s daughter Millie comes over.  She hates to have to do this for her mother.  This was not her favorite aunt anyway.  She throws  clothes in the washer or the garbage.   Most of the food gets tossed.  There is spoiled milk.  Meat with mold.  She takes all of Aunt Sally’s medicines.  She is in a get-this-done mode.  She flushes the contents of six prescription vials.  One of them was a serious dispensing error.  No one will ever know and that is usually how it goes.

I’ll repeat this story.  In hour number 12 of a 13 hour shift, I filled a prscription for the “Diet Pill” Dexamyl #2 Spansules.  (Dextroamphetamine 15mg/amobarbital).  Sort of stupid formula.

Of course, this was a One Capsule Every Morning diet pill.  The instructions on the Rx were clear:  Caps i qd.

Can I blame being tired for putting:  One capsule four times a day on the vial?   I was a young man, like 27 years old.  I should have been on top of my game no matter how long my shift was.  Clearly, I was not.

Two days later, the husband shows up, all wild eyed, “What did you give my wife?  She can’t sleep.  She has disrupted our home  All she does is clean.  She makes sexual demands.  This is not like her”.

The worst error I have ever seen showed up a month after the patient had been taking it every day.  My partner, an older late 50s man, had made the error at hour 11 of a 13 hour shift.

The patient’s skin was grey when he came in.  He had lost weight.  He looked very ill.  He gave me the vial and said, “This is not working.”   I looked at it.  Piroxicam/Feldene.  Then I retrieved the hard copy.  It was for Nifedipine/Procardia.

This one is hard to get.  Perhaps, in some convoluted thought process, the piroxicam/procardia went together.  I filled the Rx correctly.   im apologized.  The patient never returned, but he sent a letter to the company.  He did not sue.

This pharmacist eventually quit the company and moved to Utah.   It was safe there, I guess.  Close to his spiritual home.

I do not think it is a coincidence that these errors were made late in the day, after an extended period with no breaks of any kind.  After hours of mindless multi-tasking.

Let us compile a story book about all of the worst errors we have made near the end of a long shift.  Your name and who you work for will legitimize the effort.  Do it anonymously, if you must.

Let’s load up with some true-to-life stories.  They are ammunition, big guns in the battle.  Bring light to dark places!   Keep to the High Road.

Jay Pee

This is a short history of what the Vandals did to us and our industry.  I lived through it.  At the time, I had no clue what was happening.  Now, I can see that it is our fault.  Pharmacists were chasing nice pay days and they let control get into the hands of idiots.

There is a good rule:

History can definitely repeat itself if everyone concentrates very hard on making the same stupid mistakes.

Back in the day (1965), pharmacy was a 40% Gross Profit business.  We bought it for 60 cents and sold it for a dollar. 60 dollars, we sold it for a hundred dollars.  Everybody did that.  Then, in the Michigan/Ohio area, a Detroit company called REPUBLIC VITAMIN COMPANY opened up pharmacies in their stores.  After awhile, they started discounting prescriptions, then every thing else.  REVCO opened up stores all over the place in Ohio (That’s where I was at the time)  Far from glamorous, they used unfinished pine boards for shelving.  Cheap, cheap, cheap.  Price was everything.  Remember, there were no Third Parties then.  There were no credit cards in Ohio.  The BankAmericaCard came out a few years later in California.  People paid cash or check.  Credit was carried by the pharmacy.  You need a 40% Gross Profit business if you are going to offer credit.

I was in the San Francisco Bay Area in the late 1960s.  I worked for Thrifty Drug Stores and they were anything BUT the Cut Rate they advertised.   Thrifty ran 40% Gross Profit pharmacies.
Then, some bright boy ran into the executive suite at one of the other chains (I can’t remember which one was first) and said gleefully, “Hey, we don’t have to make 40%.  Let’s cut the top 50 drugs to 30%.  We will have a competitive advantage.  We will take all of the business.”

Union members, teachers, nurses and others who had prescription beneifits paid out front, we filled out their forms and they were reimbursed directly.

About 20 years, the PBMs insinuated themselves into our industry and they kept on burrowing until now it is, truly, THE TAIL THAT WAGS THE DOG.
The PBMs are for-profit engines.  They provide NO health care.  Express Scripts is no different than a big bank.  They just move money and keep a big pile for themselves.  That is a helluva lot of money that used to go for prescriptions/health care.
So, where are we?  In deep shit is where we are.  Clinically trained medical professionals who are pimps for the PBMs and Big Pharma.
The PBMs are not stupid.  They wanted to know our “Usual and Customary” charge.  Could it possibly be as good as 18%?   I do not have a clue.
They will pay a discounted value based on our U & C.  What if our U & C was 40%?  Perhaps thousands of  independents would still be in business.  The chains would not be runnin lemming-like for the cliff.  The MBAs elieve the old cut costs and look for growth.  We don’t need them.  There WILL be growth.

I have asked myself recently, “Jay Pee, are you over-the-top with your incessant snooping on CVS?”  I have heard plenty about CVS and their 14 hour shifts and the egregious manner in which they behave regarding pharmacists, chattel, galley slaves, piece-workers.  The metrics are king and professional services are neglected.  That is what I thought.  That is what I believed.  That is what so many people who say they are CVS pharmacists report.  How do I know?  Perhaps they are just ringers.
The trials of K**** H***** and 3 P X are not bull shit.  K***** took 3 P X to the wood shed.  Both sides had their hands slapped when the North Carolina State Board of Pharmacy should have rightfully taken a club to Big Evil.   We still do not know the final disposition of this case.  Any legal opening and K**** will sue.  It may have already happened.  3 P X may have already settled.   The settlement may have gagged K***** forever.  That is okay with me as long as K**** gets to pay off his mortgage, set aside a ton of money for the college education of his triplet toddlers and make appropriate investments so he and his wife will retire to a beach place on the Carolina coast by age 50.

 
Too bad K***** was not in Oregon.  Can you imagine how the Oregon BOP will look at a non-pharmacist, community college Associate degree store manager walking into the pharmacy and usurping the pharmacist’s authority? 
“You will open the drive-through right now.  A fat woman drinking a monster Slurpee complained.”   That is what the North Carolina non-pharmacist store manager said, essentially.
North Carolina has laws about such a thing.  So, what the hell….?”  K***** expressed that he was not able to safely do his job.
So, I look for anything that makes CVS look good.  A few days ago, a person who claims to be a CVS pharmacist left this comment.
“I work for CVS.  I love my CVS.  Maybe it is my supervisor.  She is concerned about both customer satisfaction and patient safety.
RxConnect (our computer system) is not antiquated.  It mostly does what it is designed to do, and works well (Rx2000 was a problem).
The problem of more, faster is not unique to CVS or Walgreens, or Kroger.  The entire industry is having this problem.  However it is as much the fault of the government and PBMs increasing regulations and decreasing reimbursement than anything.  Yes, some managers are only concerned about the bottom line. But that is not reflective of the whole company.
If you come to my store, we will treat you well.  I will counsel you on a new Rx. I will not rush, but it will be right.  It is about knowing how to both serve customers and take your time.  It can be done.
BTW I love my techs.  They are the best I could ask for.  The training is what they make of it, and all of mine are eager to learn to do things right.  I would almost guarantee that all of the stores that have these problems are missing something that they have been told to do, but aren’t.
So, I said, “Okay, Plagakis, there it is.  A comment from a pharmacist that puts new light on CVS.  This guy loves his job.
I looked at the next comment in line and the peace I felt was shattered.  Another CVS pharmacist wrote this.
“There is now a CVS policy for techs to write up a form on all staff and float pharmacists who do not follow the “rules.” I have not been allowed to see this form or get clarification as to what the “rules” are.  The lead techs have been told in our district that they are in charge.  My techs restrict this to work flow and correction of other techs but the shift in power is noticeable in the pharmacy.”
This looks like frikkin’ Nazi-shit.  CVS is a huge company.  If this is true, Rhode Island has definitely gone to the dark side.
I take it back about giving CVS some slack.  How can we look the other way when our fellow pharmacists are treated like this?
A technician spying on any pharmacist is not acceptable.  A technician behaving in this manner needs to be shown the door.  She works in the pharmacy at the discretion of the pharmacist on duty.  Not CVS. 

Is this another K***** case brewing?   Is there a pharmacist who does not need CVS out there willing to not just rock the boat, but sink the fucker?