The Pharmacy Chick

For the umpteeth time this year, I have had to process and respond to yet another drug recall sent out by manufacturers. As I was stuffing yet another confirmation of recall response into my file cabinet I commented outloud (perhaps too loud for my employees) “Do we live in a freaking third world country? Are we simply incapable of making drugs anymore that work and last thru their expiry date?” It set off an interesting conversation.

Honestly lets ask ourselves that question. In my early years of pharmacy, we’d have 3-5 drug recalls per year, maybe less. Gads, I process hundreds a year now. Most say something like “drug my not maintain potency thru expiration date”. Some recent ones like the ever popular Digoxin recall, required a lot of work of notifying patients and processing returns and reimbursements. Who is going to reimburse me and my staff for the TIME? Nobody. And then, on the heels of that one, we got the morphine recall of an erie similarity: tablet might be of double size. Back to the drawing board: notify patients and accept returns. Ironically on this recall , of the 3 patients I had, nobody would bring theirs back. Seems they get a little possessive of their narcotics. Whatever, I am not going to beat down their door. Honestly I’d think I would notice a tablet DOUBLE the size coming out of a bottle, but hey, apparently they don’t have much quality control in the plant.

Does anybody remember the ABLE Pharmaceutical fiasco a few years ago. My company was out several thousand dollars on that one when they declared bankruptcy on the heels of their own company wide recall. Now I hear the FDA wants into Ranbaxy to look at their records.

Ya know what? Maybe we need to start manufacturing our drugs in the US again. It seems I get more and more people wanting to know WHERE their drugs come from. And since India seems to be the driving force of generics nowdays, “India” seems to be the meek answer I give people more and more. I do not feel comfortable with this. I believe I have a personal responsbility to my patients to provide them with safe and effective medications and if I dont feel very confident about the source of the drugs, why should they?

I have no more control over what I carry anymore than I do the price of gas. The company negotiates contracts with whomever and we get whatever they agree to. It creates interesting conversation at the cash registers every year at this time when the “new contract” goes into effect and just about every generic I have been using has changed. I cringe when I hear a patient say something like “oh it changed again? I quit looking, it changes all the time”. Apotex this month, Ivax the next month, Aurobindo the next month after that.

It used to be that I could identify a loose tablet just by looking at it. When I carried the same generics for years, it was easy and sometimes a fun game: Identify this loose tab: and more often than not, I got it right the first time. Now, who knows.

How many times did we have a levothyroxine recall? three? four? AND, Daytrana recently sent out their second one for the same patches. Purpac (actavis) recalled most of the vitamins they manufacture. I could go on and on.

What is going on? Are drug manufacturers slacking on their manufacturing practices? recordkeeping? Do they make it and hope nobody asks? or is the FDA crossing the line and saying “hey you didn’t dot this “i” and we are going to pull your entire product line”?

Any opinions?

Tags: law, pharmacy life, recalls | |

One of the results of my recent pitching fit was the abundance of returns. This time was no exception. As much as I try, I cannot keep from having returns. I can send anything back within 30 days without a restocking fee but most of the time I have to keep stuff for longer than that. My Man Friday is good for ordering stuff that one person asks about but nobody buys. In my opinion, if something doesn’t move in 6 months, then it needs to go back. Sometimes it becomes more problematic than I think it should: partials, outdates, etc. I try to send what I can back to my wholesaler, the rest goes to the company who handles outdates.

I have some specific gripes about returns. When I first came into practice we bought a significant amount of merchandise directly from the manufacturers. When they would introduce some new and wonderful drug, they would “guarantee” the sale for us. If we bought X amount of Wondermycin, they would take back whatever we couldn’t sell if we returned it within the specified time. What happened to that? Taking possession of something nowdays is like burning a bridge behind you. “Thank you very much, good luck with that…”

AND in the olden days of pharmacy our wholesaler rep used to come by a couple of times a year and handle returns for us. He’d sit in back with his Telxon unit amongst the boxes of outdates and make them vanish for us. That service is gone too.

I tried to return some Zyrtec syrup. I purchased it before it went OTC and now I cannot return it because its “discontinued” . Well I dont give a flying whup if its disontinued. It wasn’t discontinued when I purchased it, its unopened, in date and as long as I purchased it from my wholesaler, then they should take it back. Let them decide what they want to do with it. I only bought it 5 months ago. Now I get to sit on this til next year when it finally outdates and get squat from DrugDestroyers INC.

I’m learning also how to play their game. I send back anything that arrives to me less than perfect. If the box is bent and I keep it for more than 30 days, they will refuse to accept it because it “damaged” even tho that is exactly how they sent it to me. Therefore, if its not pristine and perfect, back it goes.

When I send back my outdates I get a report from DrugDestroyers INC telling me what they are crediting me for and what I get nothing: nada: zero: the big goose egg. I get $0 for too many items now days. And, for everyone of those items there is a reference letter directing me to the bottom of the page as to WHY I got no credit for that item. There are about 30 reasons for them to deny me credit. If they can think it up, its on this page: No partials: Missing seal. Product returned is less than mfr minimum. Not in original container. Item not returnable…And it goes on. They have a lot of ways to deny credit.

I just boxed up another $4000 worth of outdates. $4000 worth of drugs I didn’t sell. $4000 I spent on inventory that didn’t move. What really gets my goat is some of the items in the box. The bottle of Synthroid 200 (1000ct) I had to order because the 100ct were out…its mostly full, The bottle of Prilosec 40mg capsules and I used 7 on a coupon offer. It was never refilled. The Cozaar 25 (#90) that I special ordered, labeled and returned to stock when it was transferred to a nearby competitor for their gift card promo. The brand name Flonase that Mr. I-gotta-have-Brand wanted until his copay went from $25 to $75. The bottle of Dyrenium (triamterene) that I used 30 out of because the Dr didn’t like HCTZ….then put the patient on Dyazide anyway. A big tube of Elocon that we werent’ successful in removing the label (therefore non returnable to the wholesaler) and since its gone generic…never moved again. A box of Arixtra with one syringe out of it…the patient got the rest of the rx at the hospital pharmacy. A box of Nitro-Dur patches with 10 missing (ok, HOW many times do I have to say–no broken boxes of nitro patches??) 2 bottles of Meridia (30ct) because they come 3×30ct and I used one…

No wonder my old boss used to pop a vein when he did returns. Its like flushing hundred dollar bills down the toilet.

Tags: , pharmacy life, rambling, returns | |

You know, in recent days Pharmacy Chick has been convinced that Mr Chick has been seeking comfort in the presence of other women. Don’t ask me how I know, I just do. After much handwringing, I finally got my proof. Devastated as I was, I am sure it was just as much of a suprise to the other woman when I caught them in the act, but you would never know it by the look on their faces. I am not sure if I’ll ever get over this betrayal, especially in Pharmacy Chick’s own bed. Scroll to see my proof!

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Meet the other women in Mr Chicks Life!

Tags: having fun, personal life | |

You know the routine, a sketchy character comes with a couple of rx’s usually an antibiotic and a pain killer and only wants the pain med. Happens all the time. We have an urgent care center nearby so this happens quite a bit. Thankfully the Dr. writes all his prescriptions on one blank so the patient cannot pocket one and fill the other. Today we had a guy bring in one of these rx’s for Ery 500 and some Vicodin. On the script the tech wrote “hold” by the Vicodin. I took a second look and asked Are you sure you got this right? Fill the antibiotic and hold the Vicodin? It was affirmed and I filled the rx. When I did the counseling he said the Dr thought he’d need some pain relief, but he didn’t hurt that much. He didnt’have insurance so he didnt’ want to buy something he wasn’t going to use.

Hell didn’t freeze over, Pigs didn’t fly…Cool.

Tags: customers, pharmacy life | |

It was Pharmacy Chick’s day off so Mr and Mrs Chick frequently use the time to run a few errands. Because we live in a metropolitan area, it often involves hopping on a freeway to get from point A to point B. Every freeway has an on/off ramp and on every ramp is a beggar. Your community may have them too, I dunno if panhandling on the freeway is allowed in your state, but it is apparently legal around here. Dirty men (and yes, women) holding a handmade cardboard sign extolling their hard-luck status in attempt to dislodge a few coins (or bills if you are a big enough sap) from your tight fist.

They are even more pathetic when its raining out, but they are out there, rain or shine. They have their corners staked out and God help you if you try to horn in on a prime spot. You’d have better luck ripping off the Mafia than stealing a good panhandle spot. Some bring a dog.

A few years ago our local paper ran an article exposing them for the scam artists that they are: a fairly well organized operation of panhandlers designed to rip you off, by pretending to be homeless, or veterans, or both. “every coin helps” says one sign. “homeless vet” says another “I have 3 kids” said a third, which was interesting cuz this guy looked to be about 65, so his kids would be, what, 30-40 years old by now??

One day I was in a long line by a metered on-ramp. It was almost 6 pm. This guy was standing there with his sign, staring off into space. He had a pack on the ground. Then he acted startled, looked at his watch (6pm), then folded up his sign, grabbed the pack and began to walk off the ramp. WHAT? Quittin time? The watch alarm went off? Time to head home? Trade places with Beggar on the opposite side? Who knows?

PC doesn’t have a heart of stone, she and Mr Chick donate over 10% of their income to charities of our choice, usually our church and a variety of non-profits of our choice. There are organizations in place for the homeless to receive meals each day, a shower and a bed. I am not going to give one man a fish when somebody more able than I can teach hundreds of them to fish and feed their entire families.

One brave soul I know spends a lot of time down town and was panhandled. He wanted money “for food” he said. Being the savvy city dweller, my friend wasn’t fooled. “lets go buy you some food” she said. “No, man” the beggar said, “I’ll buy the food, you just give me $5″. No dice.

I’ll never give them a penny, but I maybe I should keep a bag of dog bones in my car for the next time I see the dog.

Tags: non pharmacy stuff, personal life, rambling | |

For those of you old enough to remember the days before prescription insurance, this should be right up your alley. It used to be that if you received a prescription written for Drug X 30+11 refills, that it basically meant you had 360 tabs to play with. AND, provided it wasn’t controlled or you weren’t afraid the patient would hurt themselves, if they asked for 90 instead of 30, no big deal.

Then the insurance industry gathered momentum and power and ripped the spines out of pharmacists everywhere. Next, the govt got involved and politicians (Medicare/Medicaid) rewrote the rules for everything.

Today, to the consternation of pharmacists and patients everywhere, if you get a RX for 30+11, you better fill it for 30+11 or when you get audited, you’ll give that money back. You see, its fully ok, legal and actually encouraged to underpay pharmacies and rip us off, but if you have one clerical error or decide to make things convenient for the customer by saving them trips to the store, you are SO Toast.

You see, by now most Medicare D people have figured out that they can get 90 days on their plan. Pretty much every 90 day rx for a brand name med pays me under cost. However, Pharmacy Chick didn’t sign the contract so if her company is willing to take the loss, so be it. If they dont care, neither will I. I have bigger fish to fry. More and more customers are asking, no–demanding, that they receive 90 days, especially if they have met their deductible.

Problem is that the Drs seem to be a little slow on the uptake and continue to write for 30 days +11 refills (or “prn”). Take this for example: we have this HUGE clinic where 100+ dr’s have a central phone number for all their refills. We fax in our requests and it enters the big Black Hole of their refill service. Time and time again, we send in requests for 90 days and they fax back an automatic Rx written for 30 days +11. Since it takes up to 3 days for these guys to return our refill requests, I don’t have the time to send it back AGAIN. Does anybody even READ the things I fax?

Therefore I fill it as its written…30 days… I try to explain it to customers in preschool verbiage, but it doesn’t always sink in….”but I had 90 days last time…”

Sorry, but to me its the most stupid of rules. Just another way to screw pharmacies over the minutae by the insurance companies.

If Pharmacy Chick was queen of the world, I’d encourage doctors to re-think how they write their rx’s. If they want to give a years worth of refills, then write the prescription for HCTZ 25mg # 365 to be dispensed per pt or insurance requests. I did, in fact, have a dentist that used to write every fluoride prescription for # 365. Brilliant, he was. That way, every option is open for the patient , the Dr would get a lot fewer phone calls to change it, and the insurance auditor……..can go pee up a rope.

Seems like a win win situation from my perspective.

And, hope you all had a happy Independence Day. We spent all day outdoors and all evening INdoors trying to keep my drugged dogs from crawling under the couch. Pup-1 has no fondness for the fireworks….

Tags: customers, insurance, rambling | |

One would think that with the price of fuel these days that people wouldn’t be so aggressive with the heating /cooling of their businesses. Heating never seems to be an issue. I cannot think of anyplace I have ever gone into where I was shedding clothes because it was too warm. However Pharmacy Chick keeps clothes in her trunk because there seems to be an abundance of businesses who run the A/C til frost forms on the windows.

Take today for example. The Chick’s decided to grab a burger before church. It wasn’t very warm today, only about 72 and cloudy all day, so it was not like we had a heat wave going on. We got out of the car and I asked Mr Chick to open the trunk to grab my fleece. He just rolled his eyes and popped the trunk. I had been here before, I knew exactly what it was going to be like and I was right. It was FREEZING in there, in fact there was NOBODY eating inside the restaurant, everybody was outside. We joined them. We positioned ourselves fairly near the door and almost everybody who walked to the outdoor eating area said the same thing: ” Sheesh its cold in there, lets eat out here!”

Now ya gotta know that all that air conditioning is costing somebody money. Even we are fairly careful about turning on the air at the Chick household. We dont like to see our electric bills escalate into the triple digits just because we want to be cool. We save it for when we need it. So what is the purpose of having a room temperature that is in the low 60’s when its only 72 outside?

Even experts suggest you heat your house to 68 in the winter and cool it to 78-80 in the summer. Church wasn’t much better. I remember the days before somebody donated air conditioning to our church sanctuary. Granted there were some days where some fans and ice water would have gone a long way during a sermon, but I’d trade that over needing fleece in July.

Perhaps its just me. I like to be warm. I am not an Eskimo at heart. I’d wear flip flops over boots anyday and my outdoor activities revolve around sun not snow. I am the first to put on pants when it cools down and the last to go sleeveless when the temperature goes up. I am ready for a hot-flash.

Even my store is guilty of this. Until it reaches into the 90’s where even the A/C cannot even keep up, our store is routinely 65 inside. I know this because I have a thermometer in the pharmacy. I wear long sleeves all year long. I’d love to know, if they would raise the temp up to 70, how much money in utitilies would they save.

Maybe enough to give me a raise…its been awhile.

Tags: letting you in to my life | |

I have a long time customer, I’ll call Ms Brand. She has always been a really nice lady, but she made it clear from the start of time, that she likes brand name products, regardless. I learned a long time ago that it was generally fruitless to argue with people about this. Its a no win situation. They are convinced generics don’t work and even if you showed them a tome worth of evidence to the contrary, they would certainly be the exception to the rule and your credibility would be shot. In fact even if you used the generic MADE by the innovator (same product, same tab, same bottle, just different printing on the tab), it still wouldn’t work. Therefore, I just never went “there” with her. Occasionally she would accept the generic for some antibiotic I didnt’ stock…like Keflex or Cipro.

This was easy for her because she had great insurance at the time. Same copay for everything brand even if generic was available, $25. No problem, and I didn’t feel the need to intervene or interfere.

Well, as all things do, her insurance changed. She had to pay $50 for brand names and had to pay the difference between brand and generic when she took brands. She started to make more and more noise at the cash register about the price of things. Still she was not open to changing to generic meds.

One day I decided to go out a limb. I prepared a statement for her. She spends on average $2400 per year on copays. I printed out what she would save if she went for generic theraputic substitutes for her meds: simvastatin for Lipitor, Citalopram for Lexapro, Albuterol for Proventil HFA, etc.

Once finished, I had taken that $2400 down to $900 per year. I presented these facts to her. When faced with the $1500 savings, she was amazed. She said she would think about it. I figured it was a polite way to blow me off.

Well, about a week later, I got 3 pages of faxes from her dr. Every suggestion I made, she took. She came in later to pick up the drugs and said it was worth $1500 to consider trying generics. If “they didn’t work” then she could always go back to her brands, but saving over $150 per month on meds really spoke to her.

Go Me! So far so good, she has been refilling her generic meds and saving her cash.

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Fred came to the counter clutching a pharmacy bag. He had been in a few hours ago picking up a prescription for his wife. I was at the other end filling a prescription and our poor tech got the brunt of his tirade. “You shorted me 3 pills”. He was waving his bag, going on and on about who is going to take care of this, what kind of business we run around here, ripping off old people, etc. I let him rant for while. He was going to have his say, and I was going to let him. After all, Pharmacy Chick knew exactly where this conversation was going to end up. After the cork holding in his steaming brain blew off, I walked over with an overly big smile and said ” Hi Fred, Do you you remember when you came in on Friday and wanted a refill on this and we had to call the Dr?” He nodded ” And do you remember you told me you were OUT and I loaned you 3 tablets AT NO CHARGE (my emphasis added)? The blood began to drain out of his face. “well, 30 minus the 3 we gave you is 27, so your bottle had 27 tablets in it, and was marked as such, if you look at your receipt” . “oh, yes, so it was” he mumbled “never mind” and he slinked away. No apologies offered, and no apologies accepted. Marvelous tech said “He didn’t even say he was sorry?” I guess embarassment trumped traditional social graces.

Another day, Another issue: Eileen comes to the drop off window with her bag from moments ago. She was literally shaking with irritation. “This rx is $121.00? I only paid $5 for it last month.” We had had this discussion at the register on an different rx, different day day but apparently it went completely over her head. “you are in the Donut Hole remember?” “Yes, but I only paid $5 for this last month” She paid $5 for everything last month… Could it actually be she thinks this eye drop only costs $5?? I tried to explain that she wasn’t in the donut hole last month and that her $5 copay was only a very small part of the cost. “You mean I am the one who has to pay for it while I am in the donut hole?” Uh, hello, who else would you expect would be paying for it?…. yes that is exactly what it means…the unwelcome reality of the Donut Hole.

Had she asked SOMEBODY, we might have been able to keep her out of the dreaded Hole. Dump the Lipitor the Cozaar, try the Simvastatin and the ACE or Beta-blocker first. Accept my recommendation to not get the Vanos with the $35 manufacturer loyalty card, “But its FREE!” and use the Fluocinonide cream.

The donut hole has a purpose. It’s a reverse incentive to not waste the drugs you take, and be ever watchful about what these things cost. If you play your cards right, many people can get thru the entire year before reaching the donut hole. $2500 ads up right quick when your profile is full of single source brand products like the Lipitor Cozaar, Advair, Januvia, Nexium, Alphagan, and Effexor. Toss in a few infections treated with Levaquin and TaDa, YOU are in the hole.

I offered to take back her unopened box of eye drops. “but I have to have them!” She kept them but said she would get samples for the rest of the year.

Hey, I tried.

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

Pharmacy Chick decided to do Mr Chick a favor and barbecue dinner. He was slaving away digging up a root from a bush we chopped down a few weeks ago. AND since the Chick family doesn’t have a kitchen at the moment due to a major renovation (think sub floors and wall studs all that remain), we have moved into the garage and cook outdoors. I thought I should share my recipe! so, here it is.

Buy 2 packages of chicken and some fancy schmancy marinade, and marinade for 30 minutes. Leave skin on because the barbecue book you ‘borrowed’ while working says it tastes better with skin on. Figure now that you are the barbecue queen. Gently season chicken with secret stuff.

Start Barbecue…flame goes out. Start barbecue again… and again. Flame finally stays lit.

Carefully position chicken on heated BBQ, Turn temp to what appears to be LOW and begin cooking.

FIRE! Grab water bottle and spray BBQ. Remember that water doesnt put out grease fire. SH!T.

Move chicken around to minimize fire. Put out another fire. Put out yet another fire. Turn temperature down, Flame goes out. Re light barbecue for 5th time.

Question the wisdom of barbecue book-Chicken is black on the outside and raw on inside and everything is on fire. Blame the skin.

Whine to Mr Chick about the condition of chicken. Mr Chick asks why the temp so high. Tell Mr Chick haughtily that if its turned down the flame goes out. Mr Chick gently shows PC that “low” is under the control handle and, in fact, she was turning OFF the barbecue every time she turned it “down”. Oh.

Realize that instead of “low”, chicken was cooking at a temperature someplace between Blast Furnace and Volcano.

Rename “Sesame Orange chicken” “Blackened unidentifiable meat” . Figure that the microwave can cook the inside of chicken.

Serve on paper plate. Sit up straight and pretend you intended it to look that way.

Happy cooking!

Tags: personal life | |