AJ and Broncofan7 Duking It Out is Not Helpful

Jp Enlarged

I couldn’t find an image of two pharmacists fighting.  How can anyone make a living at 25 cents for 25 tablets?  But, I’d bet that AJ and Bronco could do okay if Metcalf’s was still an OTC tonic.

It may be fun, you guys, but what are you accomplishing?  I know that BEING RIGHT is the most important thing you can do.  Being Right and Making the other guy Wrong is fundamental.  Ever notice that?  Even if you are wrong you want to be right.  This is not helpful.  You may disagree on the particles, but in the end the particles do not matter.  What matters is the context, the entire picture.

For those of you who are asking, “What the hell is Jay Pee talking about?” go back to the “Magnificent Seven” post, click on the “Comments” link (Upper Left Hand Corner beside title) and read the snarky, righteous argument between AJ and Broncofan7.  I admire Bronco for his courage and prescience in running and independent pharmacy in the 21st Century.  I admire AJ for choosing a safe position with security.  I often feel the pangs of regret that I didn’t do either.  My situation in the late 1960s and early 1970s was toxic.  My marriage was a failure and I couldn’t let go.  I was a product of the 1950s.  You married and you stayed married.  I stuck it out for almost 10 years. The marriage was dead after three weeks.  A story I have told before right here.  You can find it in the pages up on top.  She was an alcoholic, a run around and a brilliant manipulative liar.  She was an incest victim of a horrible childhood.  He mother was a cold fish.  Her father got his rocks off with the teenage daughter who eventually became my wife.  She never should have married any man.  A beautiful girl, a smart girl.  I had no space to run a business even though I was a success running a small drug store for All-Med.

Broncofan7 is doing well.  He can tell you why he is successful.

AJ works for a PBM as a phnarmacist.  Okay, I hear you.  Boo, Hiss, Drag him out and tar and feather him.  But wait.  AJ gets to be a pharmacist.  How many of you can say that when your job really is chasing the numbers in the Prescription Mill?  AJ can bring a Vente Dark Roast Starbucks to work and actually have the time to drink it.     He eats his lunch sitting down and can read about Milo Weaver in “The Tourist”.  Nobody bothers him.  He makes the same money you do.  I’ll let AJ tell you about what he does at work.

Why are these guys fighting?  The problem is not with the pharmacist job at a PBM or a guy running an independent pharmacy in rural Texas.  The problem is with the Big Three.  There is some hope, but Big Question Mark is so damn careful that you won’t hear about it.

Big Stupid, Big Evil and Big Question Mark have just about ruined our industry.   There is hope with Question Mark, but when there is internal struggling more harm can be done than good if it is not handled by the upper executives with a firm hand.

So, what is wrong with what AJ is doing?  Why is Bronco being demonized when he is successful being a druggist?

 While they are fighting our industry keeps slipping away.  I still believe that pharmacists need to organize and act as a group.  Hang together or hang separately?  If you are in a guild they won’t be firing you because you are 60 years old and spend too much time attending to the needs of your patients/customers.  You won’t be working 14 hour shifts for straight time.  You will get time and a half for all hours over 8.  That comes to being paid for 17 hours straight time.  If the store manager wants to write you up for being rude, a union representative will sit in the meeting.  Your witness and adviser.  You were RUDE, by the way, because you told this customer that she would have to wait.  You were on the phone with a doctor.  The customer told the manager that all she wanted was to know where the bathroom is and you pointed at her and said in a rude voice, “You will have to wait.”

Get off your ass and call any CVS in Southern California where the pharmacists are members of the Guild.  Ask questions.   Especially ask how did they get to be Guild stores.  Grandfathered or did the pharmacists do it themselves.  It is very easy.  Once you are officially listed as an employee by the Department of Labor, during negotiations they can’t fire you even if you guys choose to walk out.

Why are AJ and Bronco fighting when the real enemies are not even pharmacists?




  1. broncofan7  •  Jul 25, 2013 @8:32 am

    Being an employee and further, being an employee of the PBM industry (like AJ)–which incidentally is one of the reasons why Pharmacy is in the micromanaging predicament it is in, is in no way shape or form a panacea for what ails our profession. On the other hand, taking ownership of our profession and becoming politically active by joining Pharmacist lobbying groups (NCPA, and in Texas the TPA, Texas pharmacy business council and American Pharmacies) is in fact helpful to our cause and the maintenance and growth of our profession. To say that my posts are not helpful is simply off base and wrong. BF7

  2. broncofan7  •  Jul 25, 2013 @8:41 am

    I am literally leading Pharmacists (in Texas anyway) right to the trough; AJ on the other hand simply denounces Pharmacy ownership and community Pharmacy in general. I’ve posted tangible solutions; AJ has posted hypotheticals about what Pharmacy leadership in academia and organizations (notice he hasn’t included what HE HAS done) should do. JP..there is no comparison between what I’ve posted and what he’s offered.

  3. broncofan7  •  Jul 25, 2013 @11:38 am

    To listen to an employee of a PBM speaking to a solution for what ails the profession of Pharmacy is tantamount to listening to a Taliban leader speak on equal rights for women……….

    Here’s an example of a PBM employee who thought that they had found job security while working for MEDCO……http://www.jimplagakis.com/?p=5973

    “Hi Jim,

    I am forwarding this email to you in the hope that it will provide a little food for thought. I received the email below as a response to a complaint I made regarding what I consider a heartless post to the PUTT Facebook page. I gotta say I’m very disappointed. I have thought highly of this group ever since I saw you mention them in your blog. Am I to be condemned as a worthless sell out because I took a great job that wound up being eliminated after the acquisition?

    While I hated losing my job I understand it was just business. For the record, I actually took a pay cut when I left the hospital pharmacy for Medco. I worked in two separate clinical departments, first in MTM and then in Cardiovascular. I’m very proud of the work that I did. I’ve done everything from save a patient $8000/ month in medication costs that they could not afford, to helping patients get better control of their disease states, and sometimes just lend an ear to someone broken by personal tragedies. These are things that every good pharmacist aspires to, and I’m very proud that Medco provided me a real opportunity to do it. While I freely admit that I don’t agree with all of their policies and practices, the same could be said for almost any employer. Are they going to condemn every CVS/RA/WAGS pharmacist as a sell out because of their employer? Not that I’ve seen so far.

    I firmly believe that if my employer had been CVS I wold have gotten a response more along the lines of ‘That’s terrible, let’s all join together and fight the good fight. Hope things work out for you.’ Instead I get a response of ‘You suck and I hope you and your license rot in a deep dark hole somewhere.’ Both companies are poorly regarded, with equally good reasons. Why the double standard? I no longer support that organization. While their goal is a good one , their attitude towards their fellow pharmacists is horrifying.

    Sincerely, RPh PharmD (Ohio)

    ———- Forwarded message ———-
    From: Dave Marley

    The heartless dirtbags are those who sell their profession down the road for a paycheck. Put simply, if you get in bed with a snake you will get bit. Mail order pharmacy exists only because pharmacists like yourself have sold out their responcibility (spelling Marley’s) to protect your profession.
    No, I have no pity those who have sold out and then got burned.

    Sent from my iPhone,

    Dave Marley, PharmD
    (c) 336-978-8107

  4. broncofan7  •  Jul 25, 2013 @7:42 pm

    This is right on cue:

    Rep. Doug Collins (R-Ga.) & Rep. Tom Marino (R-Pa.) talk about the positive impact that community pharmacies have on health care and their communities.


  5. Peon  •  Jul 26, 2013 @11:28 am

    When two guys on a blog are debating an issue, my first reaction is to find the guy that I think is ‘right’. At first, I was on the side of AJ, but, later, I read a post by Broncofan and I became confused. Both guys made good points about the issues we face. I finally realized that my normal reaction of looking for the ‘right and wrong’ of the issue was not going to work in this case. We are all in ‘the same boat’. We are all pharmacists. It does not matter where we work…we are still pharmacists. JP says it is not helpful for these guys to argue. However, I have learned some things from the argument. I have learned how two people with opposite views can enlighten me on the issues. I don’t feel that one is right and the other is wrong. For a lot of years, my primary concern about pharmacy has been the ‘work environment’. Most posters are talking about metrics and other issues that do no directly address the primary problem. In my mind, the primary problem is the work environment and the case I make is that we work in a terrible work environment for professionals. The noise and the distractions we face doing critical work is absolutely at the point of ridiculous. Of course, we face the mounting idiocy of all these metrics and all it implies effects our work environment. But, the issues of noise, distractions, constant interruptions, lack of breaks, and for some pharmacists no lunch, and the long hours at a mind straining job, are the key issues. It is the equivalent of an airline pilot having to catch phone calls while flying a plane with 200 people onboard, being interrupted every few minutes by passengers asking questions, and having to endure the plane of passengers singing, talking loudly, and the constant ringing of cellphones. But, no one…and I do mean no one will address these issues. The BOP’s are in charge of patient safety. Well, a patient’s safety is not going to be optimal if the person filling their prescription is under constant stress from all these distractions and noise. There appears to be only two areas that provide hope for us and these are legislation and pharmacists uniting and protesting. Like JP, it is time, has long been time, for us to unionize or join a guild….anything to get us together to the point that we are no longer pawns in the healthcare system. We need to organize and become very politically involved. We need ‘power’ and we can only get it by joining together and putting money where ‘our mouths are’.

  6. Pharmaciststeve  •  Jul 26, 2013 @5:25 pm

    Maybe we all need to remember that we are – or should be – advocates for the patients that we serve.

    It should NEVER be about us.. it SHOULD BE about what we need to do.. so that patients are best served and best health outcomes.

    IMO.. anyone who believes that one type of practice setting will best serve all pts.. really doesn’t GET IT !

    When our healthcare system becomes a monolith… many pts will suffer or die.

    We can’t focus on patient care.. if all we do is argue about which type of practice is the best. Let’s let the pts decide what type of practice is best for them.

  7. Peon  •  Jul 26, 2013 @5:48 pm

    Steve, you are certainly right about focusing on patients. For those pharmacists that work retail, there should be another added focus: the work environment. From my vantage point, and where I work, it looks like retail pharmacy is going ‘crazy’. It is unbelievable the amount of micro-managing that my company does. It has gotten to the point of being totally ridiculous! The issues that I feel are important are ignored. I no longer waste my time contacting the home office. We are constantly out of drugs, to the point that I am ashamed to tell the customers, and I just let the tech or cashier tell them. We have people walking out the door without paying for meds because the company will not do anything about it. A few days ago, we lost $550 on one patient on diabetic strips. Company will not do anything about it. The noise level and constant distractions are enough to drive a sane man crazy. No need to worry about us in the pharmacy, because it has already driven us nuts. So, in our efforts to ‘take care of the patient’, we must address our working conditions. As JP says, we need a union or a guild. We need a strong organization. We cannot put the patient first if our work environment is totally insane.

  8. Pharmaciststeve  •  Jul 26, 2013 @7:27 pm

    @Peon… you are correct.. however.. if we don’t make sure that the pt takes medication as prescribed.. whether it is counseling or having product in stock. Doing what is necessary that mistakes are kept to a minimum.. all of this directly/indirectly affects the pt.

    Yes, our work environment is a disaster.. but our job.. is to “protect the pt” from the system.

    If we have to join/form a Guild/Union to do that.. so be it..

    individually and collectively our goals should be the same.. regardless of work environment.

    IMO …We have lost our professional autonomy and we are harming pts because of that.. how do we get that back?

    The question also is.. how many in the profession recognizes that we have done that? If they have not recognized that fact.. they can’t/won’t change the status quo..

  9. Peon  •  Jul 26, 2013 @9:11 pm

    “Peon… you are correct.. however.. if we don’t make sure that the pt takes medication as prescribed.. whether it is counseling or having product in stock. Doing what is necessary that mistakes are kept to a minimum.. all of this directly/indirectly affects the pt.”

    There is a philosophical question involved here. Who is responsible for the patients healthcare? We all have an ‘opinion’. Is it the patients responsibility to take care of their own health? Is it societies responsibility to take care of its members health needs? Is it the responsibility of government? The answer lies in our own perspective. There is no right or wrong answer. Is it my ‘responsibility’ to insure that the patient takes his medication as prescribed? Again, it is a matter of perspective. Let us phrase it in this manner: we, pharmacists, play a role in taking care of peoples health. We are not ultimately responsible for what the patient does. We are limited in what we can do, just as every human is limited in what he can do to ‘help’ others. I think the term ‘role’ fits better than us making ‘sure that a pt takes medication as prescribed”. Playing a role in society requires that society supports us. Yes, as pharmacists, society is responsible to us too. If society values what we do and the role we play, then society must be responsible to meeting our needs. In other words, society cannot merely ignore us and think that we will always be around to play our role in society. As it is, we are being bombarded from all sides of society with factors that affect our ability to play our role. Society makes the assumption that we will be there for them. As I have stated before, my primary concern is our work environment. This is my own personal interest. I am not saying that all pharmacists should focus on this. I simply believe that there should be some people that are focusing on pharmacy as a whole and on the work environment of the pharmacist. This is not something that excludes patient care. It is inclusive. My perception, and I think there are a lot of pharmacists with this same perception, is that we are increasing faced with more and more obstacles toward playing our role in society. Our workplace is designed for a pharmacy of 100 years ago. There has not been a major change in the design of a pharmacy. The result is a workplace that is the equivalent of McDonalds. The treatment of pharmacists, with regard to work, is the equivalent of a third world country….long hours with no break. The way we are treated is ‘inhumane’. We receive no support from government regarding the out dated work practices of these corporations toward us. There are no efforts to remove the constant noise and distractions we face in our critical roles in society. I am simply saying that it is time that we got some attention. It is time that government, corporations, and state boards of pharmacy directed some attention toward our work environment. If we are so irrelevant in our society, then we should simply stop doing what we do. Let society decide if we are needed or not. Let me phrase this differently: strike! Yes, we should go on strike! It is time that society took note of us and our needs. It is time that the corporations stopped treating us like slaves. It is time for government to get off our backs and to step forward and pass legislation to force these companies to improve our work environment and to force these corporations to stop working us long hours with no breaks. I suppose you could call this a ‘whining’ post. :) :) But, these are things I would like to see. I would like to see pharmacists treated better than third world workers and to see us treated as professionals.

  10. Peon  •  Jul 26, 2013 @9:29 pm

    We have at our disposal the principles needed to guide us in our quest to improve our situation. Here are 4 principles, as spelled out, by The Pharmacy Alliance:
    4. Pharmacy professionals will counsel patients when appropriate and will advocate for a professional environment and for patient safety.
    5. Pharmacy professionals will insist on being managed by pharmacists and not by non-pharmacist managers.
    6. Pharmacy professionals will not tolerate abuse under any circumstances, directed toward themselves or their staff.
    10.. Pharmacy professionals will advocate working in pharmacies where the physical layout of the department safeguards privacy and safety. Pharmacies should be ergonomically designed.
    I think these principles pretty well sum up the points I have been trying to make regarding our work environment. If you have any questions regarding ergonomics and how pharmacists are treated by these corporations, then just take a look at the treatment of a pharmacist with MS: http://www.pharmaciststeve.com/?p=4050 . Is this enough to get your ‘blood boiling’? It is things like this that get me so angry. I am ready to protest…to strike…to do what it takes to get societies attention to the point that it empowers pharmacists so they they can get massive improvements in their work place.

  11. AJ  •  Jul 26, 2013 @9:50 pm

    “…to do what it takes to get societies attention to the point that it empowers pharmacists so they they can get massive improvements in their work place.”
    Come on pharmaciststeve…the unwashed masses don’t give a crap about pharmacy. They have the Burger King mentality. They way it their way right away. They care about how cheap it is and how fast you can put it in their hands.
    Your 4 Principles sound wonderful but they mean nothing and accomplish nothing. The public does not care. They will not support anything that adds one second on to the time it takes to get their prescriptions.
    A process improvement project such as improving pharmacists work conditions starts by defining goals that are consistent with customer demands and the pharmacists strategy. Sorry Steve, customers aren’t out in the streets demanding change. There has been no public outcry or protests concerning pharmacists not getting breaks or lunches. No grass roots protests demanding more counseling on every prescription.

  12. Peon  •  Jul 26, 2013 @10:08 pm

    AJ, you have the origin of those posts incorrect. I made those posts and I am PEON!
    “Sorry Steve, customers aren’t out in the streets demanding change. There has been no public outcry or protests concerning pharmacists not getting breaks or lunches. No grass roots protests demanding more counseling on every prescription.”
    Did you read what I said about what we need to do to get societies attention? We need to organize, unionize, or guild, and we need to STRIKE! If you shut down 60% of the chains in the US for one day, then you will get attention! It is time that we, pharmacists, got some respect and attention! I am tired of reading the wimpy posts and the do nothing attitude of so many pharmacists. I have a ‘radical’ approach to improving pharmacy for pharmacists. I think the times are now calling for something ‘radical’. We need to get out of the ‘status quo’. We need to STOP these ridiculous metrics in ‘their tracks’! We need to put some ‘fear’ into these corporations. We need to shake the foundations of pharmacy! But, first we MUST ORGANIZE. JP has seen the ‘light’ and is advocating a guild. We are powerless peons of corporations and government intervention. We are the step children in the healthcare system. We are totally ignored! Where are the blue blooded pharmacists? Where is the anger? AJ, did you go to the link I put in my last post and see the chair that was ‘made’ for the pharmacist with MS? Is this not enough to get your ‘blood boiling’? What does it take to get apathetic pharmacists to ‘wake up’ and get out of their routine of being brow beaten every day at work?

  13. Peon  •  Jul 26, 2013 @10:29 pm

    “Your 4 Principles sound wonderful but they mean nothing and accomplish nothing. The public does not care. They will not support anything that adds one second on to the time it takes to get their prescriptions.”
    AJ, those principles were formed by a group of aggressive pharmacists that tried to get a strong pharmacy organization formed. Those principles are the very foundation for what can be a strong movement in pharmacy. It does not matter about the public nor what they care. It is about pharmacists empowering themselves and pushing for change. We all know that the public does not care about us and I really never expected them to care. You only care when something is taken away from you. You never think about the ‘free air’ you breathe until you cannot get a breathe…then it becomes the most vital thing in the world. The same can be applied to pharmacy. We need to ‘remind’ the public, the corporations, and the government agencies that make laws that we are vital. Yes, no matter how many pharmacists come on this blog and say we are not vital, then lets just not go to work for one day and see if this is true.
    “A process improvement project such as improving pharmacists work conditions starts by defining goals that are consistent with customer demands and the pharmacists strategy. Sorry Steve, customers aren’t out in the streets demanding change. There has been no public outcry or protests concerning pharmacists not getting breaks or lunches. No grass roots protests demanding more counseling on every prescription.”
    It is ludicrous to expect anything from the public until something effects them. I am not that nutty. I have heard pharmacists whine for years about the public not caring about them. Well, I never expected the public to care for them. If you have a ‘mule’, the first thing you have to do is whack him over the head to get his attention. So, if you want the public to care about you, then you have to get their attention. We have been a silent minority for at least half a century. We have plugged away at our jobs while nurses having been getting more and more power within the healthcare system. The insurance companies and the PBM’s have complete control over the money we make. All I am saying is that it is time we approached this whole matter in a ‘radical’ manner. It is time we organized, unionized, and flexed our organized power. If pharmacists don’t do something, then they deserve whatever they get! You get what you tolerate! As long as we tolerate the pathetic situation of ours, then that is how long it will last. And, please don’t come here giving me negative feedback. I am tired of the ‘nay sayers’ and the mere ‘complainers’. The time is way over due for ‘action’. It is simple: I set a date for a stike…each pharmacist tell their fellow pharmacist about it and everyone get some ‘guts’ and we all walk outside our chain stores with signs and stop working for one day. It is simple.

  14. Pharmaciststeve  •  Jul 27, 2013 @2:53 am

    “people don’t know what they want until you show it to them.”

    ― Steve Jobs

  15. bcmigal  •  Jul 27, 2013 @10:10 am

    about every 2 weeks, I take my car to the local “hand wash” car wash. I already know “how much” because I choose the same package each time. The “how long’ is usually about 15 to 20 minutes. I read or visit with other patrons while I wait. I have never observed any customers rushing the workers. (Of course, there is no multitasking involved.) We are willing to be patient for a clean car, yet the public gets annoyed when pharmacists need time to do all the tasks required and still get a prescription filled correctly. AJ, you are right. Customers don’t give a hoot about our working conditions. And if corporations (esp a certain one) claim that pharmacists are not “scored” on wait time, their pants should be on fire.

  16. AJ  •  Jul 27, 2013 @1:01 pm

    Pharmaciststeve that has been my whole point all along. Expecting the general public to rise up and demand change will never happen. There needs to be a complete redirection of the profession if we want it to survive. As long as reimbursement is tied to the distribution of a product we are doomed. Pharmacists must start providing and getting paid for a service rather than a product.
    Living in the past is not helping. Continuing to pursue a path that is tied to the dispensing of a product is foolish. You know how we beat the retail chains? Give them the big F.U. and head in another direction and leave them in the dust.
    Sadly our worthless national organizations sit on their collective asses and do nothing except take big bucks from the retail chains we all know are killing the profession. Here is what the piece of shit APhA did…
    “WASHINGTON, D.C. – The American Pharmacists Association (APhA) today announced Walgreen Co. as the recipient of the 2013 APhA H.A.B. Dunning Award, the most prestigious award bestowed upon a member of the pharmacy industry by the profession of pharmacy. Walgreens was selected in recognition of efforts to educate consumers about the profession, encourage the development of student pharmacists and support advanced pharmacy practice.”
    You have to freaking kidding me?

  17. AJ  •  Jul 27, 2013 @1:28 pm

    What will APhA do next year? Give CVS the award? What a joke! And fools like broncofan want to blame the PBMs….whatever dude.

  18. broncofan7  •  Jul 27, 2013 @2:16 pm

    Pharmaciststeve wrote:

    “IMO.. anyone who believes that one type of practice setting will best serve all pts.. really doesn’t GET IT”

    For you to write that Pharmacists practicing in the community setting which entails having FACE TO FACE ENCOUNTERS with the patients that they serve is somehow equivalent to those who work in a cubicle shuffling paper in the form of processing Prior Authorizations (IE collusion between manufacturers and insurance companies in order to optimizes each company’s profits) shows that YOU really don’t get it. There is NO EQUIVALENCY. Community Pharmacists are the FACE of our profession.

  19. broncofan7  •  Jul 27, 2013 @2:22 pm

    Aj, the APha award probably has something to do with the fact that Walgreens now wants to sell sushi in their front ends ;)


  20. Pharmaciststeve  •  Jul 27, 2013 @3:43 pm

    @Bronco.. you misunderstood my statement.. I am no fan of mail order .. if nothing else.. the heat/cold that medication that is exposed to in transit..

    Not every pt can get along with a 9-5 M-Sat pharmacy, since I don’t work in retail any more.. I have to use community pharmacy.. I don’t use the drive thru.. my wife has some walking restrictions.. she does use the drive thru..

    I have neighbors in their 90′s… drive very little.. depends on having Rx delivered somehow..

    There is a need for some 24 hr stores..

    I see little need for mail order… and I consider the PBM’s just another middleman.. providing not much more than MC/VISA/AMEX.. but charging a arm/leg for same service.

    IMO .. we had a pretty good system before PBM’s, Medicare, Medicaid… showed up on the scene in the mid-late 60′s.. Nearly everything was brand names, prices seldom went up.. there was no shortages and the average Rx price was in the $4 range.

    I can remember a time when a store minimum charge for a Rx was cost plus $1 – $1.50.

    Now before anyone goes off about inflation.. if you took the average Rx price back then and apply the CPI over the years.. you would have prices in the mid 20′s.. not that far away from where the average price of generics today.

  21. AJ  •  Jul 27, 2013 @3:46 pm

    Yes broncofan they are. A face soon to fade into history if they continue to think the profession will survive by distributing a product.
    Walgreens…they would be the laughing stock of the profession if it weren’t for Rite Aid and CVS. I know JP was drinking the Kool Aid but I saw right through them 10 years ago when I first started. I lasted three weeks before I moved on. I can only imagine how bad it is now.
    Broncofan7 what do you think about the Drug Monkey? Sounds like ‘ole David has stumbled upon something out there in the land of the liberal lunatics.
    “I wrote back in April about the Clinic Pharmacy in Happy Camp, California. How it’s owner has built an honest to God clinical retail practice and makes money doing it. I am not kidding you. All the count, pour, lick and stick stuff is done by a technician. All of it. The pharmacist spends his time talking to patients, researching questions, charting outcomes and whatever else he wants. The closest he gets to your type of drudgery is when he compiles a CII order. He has pulled off what has previously been solely the fantasy of the APhA world. And he has done it while the APhA decides to give an award for professionalism to Walgreens for whatever reason.”

    You got me, AJ. I like the Kool-Aid until they prove me wrong. WAG was good to me. At the time, that is all that mattered. I hope that the good guys at Walgreens win. If not, Big Question Mark goes the way of Evil and Stupid. WAG is bi-polar. There are mid to upper level managers with real vision. Then, there are the ones who want no changes and still believe that the box of transfer gift cards and like that are the way to go.

  22. Broncofan7  •  Jul 27, 2013 @5:52 pm

    That’s a Pharmacists dream AJ… Thanks for the link i’ll check it out! Not sure where you are in Texas but I’m in a very wealthy north Dallas suburb whise citizenry has plenty of expendable income. If I can create something similar to this Pharmacist in Cali I’ll have to buy you a drink or two! thanks for the link! BF7..

  23. AJ  •  Jul 27, 2013 @6:35 pm

    I think I know where you’re at broncofan7 based on some of your comments. I used to work over there. If you opened 4 years ago or so I am pretty sure I’ve talked to you on the phone doing transfers. Ask JP for my e-mail address and shoot me a message. Small world isn’t it! I bet we know a lot of the small people if you used to be in the PBM game.

  24. AJ  •  Jul 27, 2013 @6:57 pm

    All the stuff I have been saying is not new or original. Here is an article from last year.
    “First, the pharmacy payment model must change. The 2011 report by the Office of the Chief Pharmacist to the US Surgeon General, “Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice,” makes this point…..It then points out that “for pharmacists to continue to improve patient and health system outcomes as well as sustain various roles in the delivery of care, they must be recognized as health care providers”.
    “It is difficult for a pharmacist to jump back and forth from delivering care to a specific patient and then provide drug distribution services. Of course, pharmacists may retain oversight of the process, but will not spend a dominant amount of time in this activity. This scenario will represent dramatic but necessary changes in the way pharmacists practice.”
    Guys, this is not rocket science. We must change the profession or we will become an old relic of bygone simpler times.

  25. Broncofan7  •  Jul 28, 2013 @10:06 am

    I’d really like to know how many Rxs he’s filling and how much of his business is cash derived. In today’s tough economy more people than ever are driven to the cheapest alternative if the savings are significant. The article stated he accepts only 2 third parties. That would narrow his patient base significantly in most parts of the country. And although the article didn’t go into great detail about the clinical services that he provides, the majority of people with insurance ( and in 2014-15 that will be 95% of people) will be motivated to go to get those clinical services performed by a provider covered by their insurance. Until third parties derive a viable payment system to pharmacists for providing clinical services this pharmacys business model will be severely limited by a consumers willingness to pay for it essentially twice as most people will be forced to have their own insurance. Spending $500 per month on insurance will certainly be motivating to people who may not have had that expense before the ACA to utilize the benefits if that new expense…. And unfortunately for us, the insurance companies don’t allow us to partake in these patients benefit plan other than our role as dispensers…

  26. Broncofan7  •  Jul 28, 2013 @10:08 am

    But in more affluent locales his business model may be sustainable due to the population’s amount of expendable income and desire for personalized attention.

  27. Peon  •  Jul 28, 2013 @10:16 am

    I have been hearing that the pharmacy model must change for decades. The pharmacy schools started training pharmacists, decades ago, for this new model. Yet, the new model has not arrived. Who will fill the rx’s? I know….techs. But, who will check the work of the techs? What I do in the pharmacy is primarily checking the work of the techs and counseling. If you take the pharmacist out of this loop, then just watch the errors skyrocket. The implementation of e-scripts, which was suppose to solve poor handwriting by physicians, has backfired. E-scripts are more trouble prone than hand written rx’s by physicians. To replace a pharmacist with a tech will require 5 years of college for the tech. Hmmmm…this is the equivalent of the old RPh. Do you think the pharmacy schools made a mistake when they went completely to the PharmD????? If the current model was so bad, then there would not be a CVS, Walgreens, Or Wal-Mart pharmacy. And, there would not be a Larry J. Merlo with a total compensation package of $20,330,097. If you think you can make money based on ‘outcomes’, then don’t move to my state. You will be out of business in a month! The problem here is not the healthcare system but the ‘eating’ system. The majority of people here are killing themselves eating. Until human behavior is tackled there will only be modest gains produced by basing a system on ‘outcomes’, Just come to work with me and watch these folks come riding up to the window on the Wal-Mart electric cart and ask for their meds. They weight 450 lbs and they are getting 5 bottles of Lantus and 3 Novolg Flexpen paks. Then there is the 3 bp meds, some inhalers(because they puff cigarettes like a ‘freight train’), some anti-inflammatory because of their bad knees(wonder why they have bad knees?), some heart meds, and of course something for their hemorrhoids. If you think YOUR pharmacy counseling is going to improve these patients outcome, then you better think again. The only way you can help them would be to following them around, pick out food for them to eat, and every time they started to eat the wrong thing, you would hit them over the head with a hammer to get their attention. Trying to help these people, would require millions of new health workers and a total ‘nanny’ state. I think the school systems are the place to work on this problem and the school systems have tackled this problem to some degree. What will likely be needed is a similar school system for adults. People need to be taught how to take care of their themselves, because a vast number are just too damn stupid to take care of themselves. Or, there will have to be a government crackdown on food….no more potato chips…no more sugar sodas…no more Hardee’s hamburgers. I think you get the picture. Again, another move toward a ‘nanny’ state. Our society has a lot of problems and a lot of them are direct result of the ‘nanny’ state. Welfare has destroyed the family unit in America. All these programs to ‘help’ people has created government dependents. Instead of fostering a self-help country, our government(caused by politicians bribing voters), has fostered a ‘nanny’ state that is unsustainable and will inevitably collapse.

  28. pharmacyslave2000  •  Jul 28, 2013 @3:52 pm

    Hallelujah! Holy shit Peon! Someone finally gets what the real problem is. People care even less about their own healthcare than they do about the people providing it to them. It’s just another “right” given to us by the gov’t and it’s “free” anyway.

  29. AJ  •  Jul 28, 2013 @7:28 pm

    Peon you have it all wrong. The tired old reasons you throw out there don’t help. It has been proven time and again to double check someone’s work does not require a PharmD or even a pharmacists license. I know plenty of pharmacists who could’t catch a mistake if were attached to the flu virus and someone sneezed it in thier face. You stated the problem quit clearly…you spend the majority of your time double checking techs work. Really? And you consider this practicing pharmacy.
    The reason nothing has changed is the money that has been made off distributing a product. As long as that money is good why change? Well things are about to change and there will be very little money made on distributiong the product.

  30. Peon  •  Jul 28, 2013 @9:49 pm

    AJ, no, you are the one that has it all wrong! Retail pharmacy is here to stay. And, I do the job of a pharmacist. What I do is vital and I cannot be replaced by a tech. As far as you knowing pharmacists that cannot catch a mistake, then they do not work where I work. I think you just insulted every chain pharmacist in the US. And, for your information, we chain pharmacists play a vital role.

  31. bcmigal  •  Jul 29, 2013 @2:34 am

    Peon….don’t be so sure of that..


  32. AJ  •  Jul 29, 2013 @6:45 am

    Sorry Peon sometimes the truth hurts. Retail as it currently stands is already being phased out. As a community retail pharmacist you are part of the most inefficient and expensive commodity distribution system mankind has even known. It is not sustainable. The affordable care act will finish it off.
    You better change your attitude quick if you think you cannot be replaced. You can and will be.

  33. AJ  •  Jul 29, 2013 @6:58 am



    Tech-check-tech coming to retail pharmacy soon…You said it yourself Peon. You spend the majority of your time double checking a techs work. It doesn’t take a pharmacist to verify information was typed in correctly or the picture on the computer screen matches the pill in the vial. You have a massively overinflated sense of selfworth and value as a retail pharmacist. Again truth hurts I know.
    I challenge you to keep an exact count of the number of patients you provide meaningful counseling to for one week. The behind the counter telling someone not to refridgerate Omnicef suspension does not count. Real APhA or Indian Health servive counseling.
    Then keep track of all the major drug interactions and other major interventions you did in the same week. I am talking about major things that required a call to the doctor to avoid serious patient harm.
    At the end of the week compare the counseling numbers with the number of new prescriptions that were filled on your shifts. You will find you counseled on less than 5% and had zero major interactions or interventions. And you think what you do is valuable and worthy of 100k plus a year?

  34. AJ  •  Jul 29, 2013 @7:00 am

    Come on JP your doing it again! Why are all of my comments all of a sudden awaitiing moderation!

    A mystery to me, AJ. Perhaps the WordPress spam filter notes the links you include and
    thinks they are spam.

  35. Peter Dumo  •  Jul 29, 2013 @11:55 am

    I’ve read this back and forth and thought I’d chime in. First of all, the model of clinical community pharmacy described in Drug Topics does exist. The pharmacist that works with me has been here four hours already, and he hasn’t checked an Rx. We’ve managed 6 coumadin patients, consulted on a diabetic who’s lost 40 lbs and we are DOWN-TITRATING insulin, adjusting someone’s BPH treatment, just to name a few of the clinical services we’ve provided. 90% of these services are reimbursed via the Ontario MedsCheck program (similar to MTM in the US), although reimbursement could be better. At the same time, reimbursement for Rx filling is shrinking. We recognize that payors see less and less value from the distribution of drugs, but are starting to see value for the appropriate management of drugs. Currently, our model has about 25% of operating revenues coming from clinical services. We’re hoping to drive that to 35% in the next 3 years as margins on prescriptions shrink further. It isn’t a pipe dream. Will you have to develop a model that fits with your location – yes. Clinical services may not be a business building model in certain areas, whereas in others – it’s fabulous. Think of it this way – CVS, Walgreens, and Rite Aid are everywhere. They’re the McDonalds of pharmacy. Volume in/volume out. Can you compete with McDonalds at their level? Probably not. Instead of trying to be McDonalds, try and be the Capital Grille. Go for the high-end/high-service segment of the market, but charge accordingly.

  36. broncofan7  •  Jul 29, 2013 @3:52 pm

    AJ wrote: “Sorry Peon sometimes the truth hurts. Retail as it currently stands is already being phased out. As a community retail pharmacist you are part of the most inefficient and expensive commodity distribution system mankind has even known. It is not sustainable. The affordable care act will finish it off.
    You better change your attitude quick if you think you cannot be replaced. You can and will be.”

    Community Pharmacy being phased out? Really? And if that were the case, why do you seem so glib about that? Almost 7 out of 10 of us work in the community either part time or full time. Add to the afct that there are now ~129 Pharmacy schools in the USofA and salary pressures will reach every aspect of current pharmacy practice.If community Pharmacy is being dealt a death blow it’s a death blow to our entire profession.

  37. broncofan7  •  Jul 29, 2013 @4:02 pm

    That’s why every single one of us no matter if we are employees or owners, whether we work in a hospital, community or PBM office, need to support the NCPA and research to see which Pharmacy groups are active in our respective states and donate 2 hours worth of pay to those organizations every year. In Texas it’s




    And I’m sure that there are those of you out there who are thinking as they read this…”I’ll be damned if I’m going to donate $120 to some Pharmacy Organization! The APhA does NOTHING and they’re the largest!”—and the enemies of our profession, the PBM’s and the corporate mostly NON-Pharmacist bean counters at the chain stores WANT you to have that very outlook. AJ proclaims that he wants Pharmacy to move away from dispensing of a product; most of us post 2000 graduates (some even prior to then) would like that as well. But AJ’s employers are not putting forth the economic framework support needed to make such a transition viable. Even Nurse Practitioners who by law are able to practice without supervising physicians are limited in practice by Insurance companies who are not providing them an even playing field. Ceding direct supervision the dispensing role and handing our economic viability over to the insurance industry is NOT the panacea for our profession. Nurse Practitioners are a great example to providers everywhere of that fact.

  38. Broncofan7  •  Jul 29, 2013 @8:05 pm

    And the average gross margin on a prescription is currently $12.50. Our community pharmacy dispensing model is not what makes the distribution of drugs expensive; it’s the manufacturers using the US market like a bottom-less piggy bank. nexium went up last month from $190 to $215 per 30 count bottle. 5 months prior to that it had also increased in price…. And for what reason? Lack of raw materials? No. It went up In price simply because manufacturers CAN raise the price and they know full well that 3rd party insurance companies make that $228 per 30 count bottle of nexium palatable at a $40 copay ( or $18 if patients are smart and go to purple pill.com). The true expense in the delivery of pharmacy services isn’t the providers of the service; it’s the brand name ( and increasingly generic — see desonide and depakote er) product itself. The ACA will hopefully place caps on manufacturers and their pillaging of our economy..

  39. Peon  •  Jul 30, 2013 @9:05 am

    Broncofan7, you are so right about the manufacturers and their pricing. No one seems to be looking at the pricing model of drugs. As you say, the manufacturer can raise the price of their drug to ridiculous prices, as long as the copay is palatable to the consumer. This is a major problem with insurance companies paying for peoples meds…people are not concerned with the overall price of the med, only their copay. The average consumer has no idea about the cost of their medication. The only thing they notice is the ever escalating cost of their premiums. They wonder why their premiums are so high. If insurance companies would stop paying for Nexium, you could just watch the price start dropping like a rock.

  40. broncofan7  •  Jul 30, 2013 @5:42 pm

    Hey AJ, best Eggs in the world! Come get some….Thanks for introducing me to MR. Stanley’s columns…


  41. AJ  •  Jul 30, 2013 @7:01 pm

    Great article! The Drug Monkey rules! I just about threw up when I read this! I saw many of those during my tenure in retail hell! Hell, I even had a 2 hour personal meeting with the pharmacy supervisor because the store manager just barged into the pharmacy one night without asking so she could conduct an “inspection”. The store manager called the pharmacy sup because she was concerned I was no “on the program” because the Key Retailing metric chart was not filled out correctly. The floor, according to the chart, was supposed to be vacuumed twice a week and there was only one boxed checked on the chart for the previous week. I said my goodbyes shorty after. I hope to God I never have to go back.
    Subject: Pharmacy Service real time update *URGENT*

    Date: Fri, 25 Mar 2011 10:20:12 -0400

    From: XXxxxx@xxx.com

    To: ;

    Team 4,

    · We are self destructing this week on rx service!!!! 84.7; two days left let’s pick it up TODAY!!

    · 59.2 on addressed by name, 63.6 on wait time- Are we serious??? Do you think I will accept results like this?

    · Wake up and start delivering excellent service results NOW!!! You’ve worked too hard this month to throw it all away

    · If you’re not able or willing to lead your team to deliver excellent service to each patient each time please let me know so we can discuss your exit strategy- one thing I won’t accept are poor service results &; neither should you
    - See more at: http://drugtopics.modernmedicine.com/drug-topics/news/best-eggs-world?page=0,1#sthash.MEW5yvb0.dpuf

  42. Pharmaciststeve  •  Jul 30, 2013 @9:43 pm

    @AJ.. if you post more than one link in a post.. the spam filters consider it a questionable post.. and requires the blog’s owner to approve the post …

  43. AJ  •  Jul 30, 2013 @10:34 pm

    Can Jim override that? It just happened again. How does broncofan7 post something with 20 links in it with no problem and I can’t post something with one link in it.
    Ahhhh…I see, JP is just trying to keep me down!

  44. Pharmaciststeve  •  Jul 31, 2013 @5:29 am

    @AJ… this blog’s system will even put mine up for review if I put more than two links in one post.. you are just being paranoid ! After all, it is JP’s blog.. if he wants to put/keep such a filter in place.. it is option..

  45. broncofan7  •  Jul 31, 2013 @8:18 am

    BMMIGAL…those kiosk machines still are supervised by Pharmacists. http://www.medavail.com/company.html

    They are great for Rural areas where the community cannot support a full Pharmacy on it’s own.

  46. bcmigal  •  Jul 31, 2013 @12:53 pm

    Bronco….I was merely pointing out that the physical presence of a pharmacist is not necessary….and we should not think for one minute that we are indispensable (pardon the pun)

  47. broncofan7  •  Jul 31, 2013 @6:55 pm

    Only in very RARE, incredibly defined circumstances is a Pharmacist not required to be present. Remote Telepharmacy and remote kiosks are examples of this and are largely restricted to rural areas (otherwise I’d be placing one in every urban hospital I could).

  48. broncofan7  •  Jul 31, 2013 @7:00 pm

    Just another reason why all of us, no matter where we work, should begin or remain active in our Pharmacy organizations because all it takes is the stroke of a pen to change our profession forever….it’s important that we as a profession influence the dictation of that pen at every opportunity…..

  49. bcmigal  •  Aug 2, 2013 @12:24 pm

    Bronco…just fyi from CA B&P code 4115:

    ” (g) Notwithstanding subdivisions (a) and (b), the board shall by
    regulation establish conditions to permit the temporary absence of a
    pharmacist for breaks and lunch periods pursuant to Section 512 of
    the Labor Code and the orders of the Industrial Welfare Commission
    without closing the pharmacy. During these temporary absences, a
    pharmacy technician may, at the discretion of the pharmacist, remain
    in the pharmacy but may only perform nondiscretionary tasks. The
    pharmacist shall be responsible for a pharmacy technician and shall
    review any task performed by a pharmacy technician during the
    pharmacist’s temporary absence.”

    The non discretionary tasks include typing and filling as well as selling a refilled prescripion to a pt. The pharmacist does not even have to remain in the building for meal or lunch breaks. And yes, in California, pharmacists are non-exempt and uninterrupted meals breaks are mandated by the IWC after 5 hrs of work. This has been the case since at least 2001.

  50. Broncofan7  •  Aug 2, 2013 @10:11 pm

    Neat. And the Ca law states at the discretion of the pharmacist during temporary breaks. That’s reasonable. But how exactly does that apply to your assertion that you made to Peon with that link you provided about the dispensing robot and how that will someday replace a pharmacist in the community setting? Here in Texas a small chain store called drug emporium actually had the pharmacist go home at 5pm on Saturdays and closed the pharmacy but had their will call section outside the pharmacy drug storage area open until 8 pm with a pharmacy technician working those 3 hours minus an RPh with Rxs that were ready to pick up. They simply had to provide a note with a toll free phone number for counseling to the patients. Here in Texas whenver a prescription is mailed out we have to provide a notice to the patient stating that they have a right to counseling if they have questions regarding their medication and we have to provide our pharmacy phone number.

  51. Broncofan7  •  Aug 2, 2013 @10:12 pm

    In English AND Espanol by the way….

  52. anonymous  •  Aug 4, 2013 @6:41 pm

    The best eggs email has to be from CVS. Not that Rite Aid and WAGs are that far behind. I love (hate) when the DM writes “you have all worked too hard.. if you cannot do this let’s discuss your exit strategy (you’re fired). Why aren’t the DMs fired for poor performance? Mine should have been fired. The threatening emails make them and their supervisors look bad. Ryan Barna took months to get fired for the same reason. He landed another job in no time. If there was a true businessman at the top, he/she would realize metrics have little to do with success and everything to do with wasting time and money to try to save time and money. My former DM, with this guy it was every day with the threatening emails and the twice daily conference calls during flu season during the busiest time of the day. This was Rite Aid. On a side note, I would never ever trust a tech to do a pharmacists job, ever. That’s like saying a nurse can do a doctors job.

  53. bcmigal  •  Aug 8, 2013 @2:12 pm

    My complaint of the day is that there is not enough time to fill a prescription properly. Drop off is overwhelmed with typing, calling doctors, insurance companies, and patients. Production is up to the eyeballs in filling, phone calls, and pickup. Let me get started on the tasks of the QA person: answer the calls on hold, take new rxs, listen to VM in less than 15 minutes, help in typing escripts, rewrite refill rxs for controls, call pt whose rxs are in willcall, order foa’s, fill waiters if production is busy, fax/call for new rxs, and monitor the tasks included in the metrics. What did i miss? …Oh, verify prescriptions, too?

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