The Pharmacy Chick

Pharmacy Chick was internet surfing the other day when she came upon a little news item that yet another major pharmacy and grocery chain was joining the ranks of the apostates and offering the $4 prescriptions on “over 300 drugs”. (bear in mind that warfarin 1,2, 2.5,3,4,5,7.5,and 10mg counts as 8 drugs). I wish I could ask WHY?

Pharmacies have never been known for their intelligent decision making. But this one takes the cake. When Walmart ( I can use their name because its widely known) came out with their $4 offering, I bravely hoped that it would be a passing fad. After all, pharmacy amounts to what? 2% of their business? Who cares if they lose money if they can get Mr Joe Six pack to fill his cart while waiting for his $4 loss leader. Target followed later with their own list. Target is a relatively new player in pharmacy. Now its Kroger. I don’t know much about these guys, they aren’t around my neck of the woods. But Pharmacy Chick is hopping on her soap box for a few observations:

95% of my business is already managed by health insurance. These are people whose prices are already fixed and the rate of reimbursement can be called sucky at best. There are a few precious plans that have a fixed generic copay, $10 for example whether its 100 metformin or 2 lorazepam, its 10 bucks. Why are we giving a PBM incentive to cut our reimbursements even more? Ya’ll think they are blind and won’t notice?

The few cash payers that I have left are snatched up by “discount cards”. What the hell is this? Since when can Quickie Lube and Tire offer a card that decides how much I can or cannot charge for my services? Why did we ever accept this from the start? When I used to work for Joe Independent, he refused the cards. “If its not insurance, I’m not takin’ it!” And he didn’t.

Generic medications were the last bastions of profitibility in the pharmacy. If we bought it for $2 and sold it for $22, we made a tidy $20 gross profit, which was still a great deal over the $99 it would have cost the patient for the brand name. I dont care what you say, there isn’t going to be great profit in some of these auxilliary services like vaccines and MTM, they are too labor intensive. It costs a lot of labor to run those services, and in no time, PBM’s will be cutting reimbursements to is for them too. Just wait, you will see. Why are we buying the rope they are hanging us with?

One of my buddies works in a pharmacy that will price match the $4 when asked. He doesn’t get asked very much cuz he works for a discounter that sells stuff pretty cheaply already. The “when asked” part bugs me. If you are gonna do the $4 deal, either do it or don’t, this sliding scale thing bothers me. That means you have to keep track of Ms C who gets her Lisinopril for $4 and Mrs D who gets hers for $12.99. In fact the whole price matching thing gets me going, but that is a blog on its own, suffice to say that Pharmacy Chick thinks that if you are gonna do this $4 nonsense, either jump in or stay out, sticking your toe in only is gonna cause trouble with customers.

Imagine this, cuz I already have: Its a big conference room, BPOP (Biggest PBM On Planet) is having a meeting with all their decision makers. They have, in front of them, the lists of all the $4 prescriptions that all these players are offering. Mr Big in his bigger suit stands up and addresses the group: “Gentlemen, we have a golden opportunity here, these jokers have cut their own throats, and we dont have to do it for them. All we have to do is rake in the profits, because effective at next renewal period, all these meds will be contracted at $3.50. If they can accept $4, they will accept $3.50″ HAHAHA, ” Lets go have lunch, and take the rest of the day off, we didnt’ have to earn it, they just gave it to us.”

Its the beginning of the death of pharmacy, and unfortunately for us, this one can only be classified as “suicide”.

Tags: competitors, national news, pharmacy life, prices, ranting | |

This is specifically for new pharmacists, or at least those who might have been practicing for a short period of time…ok and even interns who are just about to take their boards.

Smartly dressed with a crisp white jacket with a gleaming new “RPh” after her name, she was overwhelmed by the reality of working in a busy retail store. She snapped at the techs, got lippy with a customer. She was disorganized and didn’t take constructive assistance very well. It was her way or the highway. The problem is, she wasn’t experienced enough to have a “way” that worked well. She was also floating, a position fraught with difficulty already. I heard all about the day.

When you became a pharmacist you probably figured it out right away: its completely different than when you were an intern. Overnight, all the rules changed. No longer could you hide behind a counting tray while the pharmacist ironed out all the messes. You now hold the iron. Gone are the days of being the “extra” person. You work alone. Forget about coming in late or leaving early for dinner plans/a play/a wedding/CE seminar..whatever. Tag! you are IT! Welcome to Jail: Do Not pass Go, do not collect $200. Most likely you weren’t quite prepared for it. No newbie is. I certainly wasn’t. I waved my just-arrived-license in the air and the pharmacist dropped his spatula and announced “I am taking the rest of the day off”. Once I picked my chin off the floor I realized he was serious. He grabbed his coat and left. Just like that, he was gone. Whoa.

The safety net was gone.

I have a few words of advice for the newly minted pharmacist (or rph soon-to-be)

1. Pharmacy school only gets you a license, it does not teach you to BE a pharmacist. That takes time and a good mentor. You are not done learning just because you passed your boards. In fact, you are just starting. Everything in school was black and white. In reality, everything is a thousand shades of gray. What works for one person will fail miserably with another. Don’t expect to have a policy that works in all situations. It won’t and when you understand that, you will have a better chance of surviving your career. Be flexible or you will get broken.

2. You are not better than everybody just because you make 6 figures now. You may have all sorts of facts and figures memorized, know every therapy course for every disease state, but you have nothing on Clyde the 60 yr old pharmacist who has a following that can only be described as “cult”. He takes care of them. They love him back. He may not have the most current protocol in the anti-coag clinic memorized like you do, but he has the respect and admiration of a thousand people. Try to pull that out of your palm pilot!

3. A haughty attitude will get you nowhere. Trust me. I learned the hard way. If you have chip on your shoulder, somebody is gonna knock it off. You will not command respect or believability simply because you got the white coat. In fact, expect that people will look to your OLDER techs for advice instead of you until you age a bit. It will be harder on you if you are young and female than if you are young and male. You are gonna look like children playing dress up to some senior citizens. Get over it and move on.

4. Look at people thru different eyes. People tend to see what they want to see. If you train yourself to find some good in everybody, you’ll be able to forgive them when they disappoint you, and more importantly, they will forgive YOU when you disappoint them.

5. You never have the right to be rude. N.E.V.E.R. Unless you are signing your own paychecks, you will always have a higher authority to answer to and rudeness will never be defended by your boss, even if its seemingly justified. You will just end up looking like a dink.

6. It is rarely the message that offends somebody, its usually how you say it. If there is one thing I would teach in Ph- school is Effective Communication. Don’t talk at somebody, Talk WITH them. Use your ears, and not your mouth. Its ok to say to somebody “If I understand you correctly, you are saying…..” If they think you understand them, you have won half the battle. Empathize. If somebody believes that you are on their side, they will likely not give you as much grief. For example: Nobody likes to hear that their refills aren’t ok’d by the dr and its been 2+ days. But to curtly drop the news on the table like a sack of potatoes will irritate the patient. Try this: “I understand your frustration! I makes us crazy too–who needs that kind of time? It seems way too long doesn’t it? We have asked them twice and they still have not responded. Perhaps you might like to ask them, since its your dollars that pay their wages huh?” If the patient in my previous post had heard that (instead of the curt response he did hear) I’d likely not have had to spend a half hour listening to him chew my rump.

7. Read How to Win Friends and Influence People by Dale Carnegie. I mean it. READ IT. Twice. Its a small pocket book with a wealth of information. It changed my practice forever. His principles are timeless and people will pay $1500 for a seminar teaching his techniques.

8. Be friends with your customers. Do not create an adversarial relationship with them so when you mess up, and you WILL mess up, they will be less likely to sue your butt into poverty. They will also be more inclined to do things your way if they LIKE you! Think of this common example: if you grab a dog by the collar and pull towards you, what is gonna happen? He is going to resist! Its his nature. So it is with people.

9. Your techs are your ass-savers. They can make or break you. Some are better than others, but try going it alone for a few hours and even the sketchiest of techs help you more than you know. Just because they don’t have a degree doesn’t mean they aren’t valuable, so don’t condescend to them. Actually dont treat anybody condescendedly.

10. Don’t drop the ball. If you say you are going to do something for somebody, then you better do it. And if you couldn’t do it, then you better have tried everything in your power before you failed. You will be called to be accountable for what you do or don’t do, and you will look darned silly if you drop the ball. I can honestly say that if I couldn’t do something for a patient, they KNOW that I have done my best.

11. Don’t roll the dice: you will be surprised at who knows who in the community. I’ve always been surprised at the few degrees of separation some of my patients have. People I would have thought had no connection whatsoever are best friends, or neighbors, or go to church together, etc. Its often AFTER the fact that I hear from a (sometimes challenging) patient (that I would have liked to get rid of) “Thanks, Joan Jones sent me here”.. Whew..that was a close one.. I go to church with Joan…SEE?

I guess what it boils down it is live the golden rule when you step behind the counter. Your patients may not be as good to you as you are to them, but they’ll never have the upperhand on you if you keep your composure, have realistic expectations, learn your limits, behave properly, and become their advocate.

Tags: customers, employees, general junk, pharmacy life, words of wisdom | |

There are several constants in the world. The earth spins on its axis at a certain rate, the sun rises in the East and sets in the West, and Pharmacy Chick has to call some pissed off customer after every vacation. This time it was two…

Over the years I am less and less inclined to make apologies for things not my fault. Call it callousness if you will, but I spend enough time apologizing for stuff that my staff IS responsible for, that I am not going to make ammends for stuff that is NOT our fault.

Person #1- brought in a prescription for Anotherazepam #90 for 1/2 q 6 hours. This plan limits to 30 days so the pharmacist “took it upon herself” (quote of customer) to adjust the quantity to 60. It was completely appropriate given 1) insurance audits are unpleasant and 2) the last time the patient got the med was 4 months ago. She took some exception to this adjustment made a bit of a stink. I didn’t fall for it and I didn’t make apologies. If the doctor writes a certain sig, then we are obligated to submit a days supply that is consistent with it. Bite me. (ok, I left that out of the conversation). He had his dr change the sig so he would get the other 30 and had the pharmacist rebill. (So what are you whining about again?–YOUR dr screws up and its my fault? Bite me again!)

Person #2 ordered a refill that needed Dr’s auth. He came in later and Dr hadn’t called back. In fact, this is ongoing with his Dr, and he knows it. This time, with relief pharmacist around, he decided to bring out his bad behavior. It was “unacceptable” to have to wait 2 days for a refill .A couple of days later he told my partner that he is transferring his prescriptions elsewhere.

Personally, I agree– it IS unacceptable to wait that long, but until somebody elects Pharmacy Chick as dictator-for-life then that’s how it goes.

So here’s the deal–Don’t threaten to transfer prescriptions–it is not gonna work with me. I don’t care. I will make the same amount of money whether or not I have to put up with you. I am not going to grovel–its not my nature. Its a free country, you can go wherever you want, and I am ok with that. For every one I lose, I’ll just bring one in that’s pissed at their previous pharmacy. I call it the revolving door: In and Out. See ya around sometime.

Tags: customers, insurance, pharmacy life, ranting | |

Oh my word, there is nothing like spending several hours at an airport to see the twisted weirdness of all humanity. Here are some of my favorites–I wish I had caught them on camera. These are all real.

1. The 70ish woman dressed head to toe in tight leopard skin print fabric. Ask her age and risk decapitation. She likely would even lie to the TSA if they asked her date of birth. Her matching dog carrier twitches around and contains what looks like a doglet–a very small furry creature that probably eats better than many people. She has glasses half the size of her face and big chunky rings on several fingers. I dont know where she is going but I would suspect Palm Springs or Las Vegas.

2. Mr Rotundity- This guy was as wide as he was tall. I was grateful when he walked by our gate. He should have been charged for 2 seats because he sure the hell wasn’t going to fit into any single seat I have ever been on in a plane, unless its first class.

3. She had pink stilletos and a matching pink coat. Ms STYLE! Blonde hair (fake, I could see the roots) and when she had to take off the coat and heels to progress thru security, she revealed a little black dress that could only be described as a slip with beads. Wow.

4. The Japanese tourist: I can say this because the Japanese tour group leader was at the head of the troup. Who’d have thunk you could need 3 cameras? around one neck? at the same time? And do you really need a picture of the luggage carousel?

5. The screaming child. Does EVERY flight have to have one? Is there some screening process that makes sure that every single flight, no matter how full or empty has at least one unruly child who appears to have been pinched or punctured immediately before boarding the plane? And must they sit within 2 rows of me everytime? Not even the most powerful noise cancelling headphones will drown out the noise of this one. His mother was frazzled and she also had a toddler in tow. God help everybody else on the plane. Its gonna be a long flight no matter where they are going.

6. Giant. Him, I feel sorry for. He’s about 7 linear feet of human, being crammed into about 5 1/2 linear feet of cabin space. I have to believe that if he could afford first class, he would be there, but no, he is standing in line with the rest of us flunkies in coach. I am glad I am short enough to fit reasonably into a airplane seat.

7. Mr E-nut. He had his computer going in the gate, and had enough gear to open his own electronics store right there on the plane. He had a plam, a dvd player, his laptop, a cell phone, a game toy. The second they allowed the use of his stuff, he had it out.

8. the pack rats– ok this constitutes a lot of the people we saw. Whats up with this anyway? I am talking rolling duffles, mini suitcases, huge backpacks, shopping bags, strollers !?!, people dragging enough gear to survive for days ONTO the plane. One lady had a rolling suitcase. Sorry, but Pharmacy Chick feels that if you cannot carry it onto the plane, you have no business bringing it onto the plane. She couldn’t even lift it above her head and required assistance to get it into the overhead carrier! Come on folks.

9. Ms Haute Couture. I wish I had in my wallet what this woman was wearing on her body. This 40ish woman had Louis Vuitton (sheesh, I dont even know if I spelled it right) luggage, Tiffany Jewelry, Ralph Lauren pants, etc etc. Everything had a name, and it was expensive. I doubt the clunky ring on her left hand was anything less than $30,000 of diamond and her accompanying male ( husband’s second trophy wife?) could be accurately imagined as a balding pimp. Oh, and they were first in line at security with their Premier Mileage First Class Gold Club card. I’d bet their destination was a lot fancier than mine was.

10 Business Traveller. These suits are still doing it nicely on their corporate dime. They look the part, (before the flight wrinkes their $400 suit), and if they are in pairs, talking the big deal. Four or five of them were in the bar watching the baseball game on the plasma overhead. All ya have to do is talk a little business and write off the $8 beers at the airport.

11. The spring-breakers. I have never flown during spring break, likely never will again. Where do all these teens get the money to fly someplace warm and exotic on spring break??? Criminy, when I was in school, I had to work over spring break, waiting tables to earn a few dollars. If I had told my mother “Mom? I would like to fly to Cabo or Orlando for spring break.” she would likely drop the floor in hysterics, wipe the tears of laughter from her eyes, then say ” Seriously, you had me going for a minute–what time do you start your shift?”

12. The Family man–I wish I could get inside this man’s head. He is trundling along with his wife who is trying to keep track of 3 kids, all under the age of 10. I’d bet they were going to Disneyland or Disney world, but I’ll never know. They weren’t on my flight. If I was gifted with reading minds I’d say he was thinking ” God, what was I thinking when I booked this vacation? 6 months from now they won’t even remember we went! I should have left them with my mother and the two of us could be sitting on a Baja beach deciding whether we want our margaritas with or without salt!”

13. Lucky thirteen. Saved the best for last..if you are still reading this– Lady, if you read this, sorry for you. I watched you polish off a bag of Chips-Ahoy chocolate chip cookies, then reach into your purse and load up on 80 units of Humulin N and inject yourself right thru your pants. Thanks for tucking the syringe back into your purse and not throwing it in the garbage.

To quote from the famous Hindenburg disaster: “oh, the humanity of it all”

Back to work tomorrow and more blogworthy entries for sure!

Tags: general junk, personal life, vacation | |

Pharmacy Chick is back! She loves BEING on vacation, but honestly, she does not like GOING on vacation. All the packing and unpacking, the hassles. This trip was no exception. If there is one thing that is common with pharmacists (especially managers), is that many are control freaks. I am very much a control freak. I like all my ducks in a row…all the time. Likewise, there isn’t much that takes me out of control than flying. I have to trust that the porter will route my bag to the right plane (did I tip him enough?), I have to trust that the TSA people (who look like they had vinegar and lemons for breakfast) will not pull me out of line and make me miss my flight, and I have to trust that the pilot will get me to my destination in one piece and on time.

The Chicks have been all over the world….twice. I am not afraid of flying, but I dont particularily like it anymore. The planes are crowded, the airports congested, the people rude, the “food” they serve is barely “food” any more. However once I reach my destination, I have a wonderful time usually.

We had 60 rather tense minutes this time however. For the most part, I have never lost any bag while flying, tho sometimes pieces and parts are missing. I never arrive late, I have my bags marked well, and I believe in the power of prayer (Oh dear God, please let me see this suitcase again!). We arrived at our destination and with the other 200 people waited for the luggage to arrive. Soon enough lots of bags starting shooting out of the chute and one by one people started claiming them and walking away. 20 minutes later Mr chick and I were still staring blankly at the chute where no more luggage was coming. About 30 others were also staring at the same spot. Soon however more baggage started to arrive, but it was clear this was from a different flight. Ok, NOW we were getting nervous.

Not wanting to be the last in line at the Lost Luggage Dept, I made my way over to the small office and started to place my inquiry with the Lost Luggage Dude, LLD for short. He sleepily took my information until he realized that I was one of about 30 people all looking for the same thing. Apparently one person with lost baggage is acceptable, 30 is not. What troubled me more was the fact that the plane was scheduled to leave the country and I didn’t want my bags to fly international while I was only going domestic!

LLD announced that the plane was not going to leave until it was determined that our luggage was not on the plane. Small solace, because he didn’t determine if our luggage ever got ON the plane. A million scenarios went over in my mind as I mulled this situation, not the least of which is this: I am wearing every bit of clothing I can access at this point in time. I travel light. I dont need a rolling duffle on the plane with me (a later blog, just wait), so unless I need it ON the plane, I check it.

This story has a happy ending for all of us. About 40 minutes later (a realllllly long 40 minutes) some guy on a walkie talkie announces that one more cart of luggage from our flight has been “found” and will be off loaded to baggage claim shortly. I never found out if it was on the plane and removed or if it was just forgotten, LLD didn’t offer it up. I don’t care. When I saw that blue suitcase pop out I was one grateful Pharmacy Chick! Vacation ON!

Tags: personal life, rambling | |