There is a common saying that goes “You cannot help someone who will not help themselves”.  Pharmacists deal with patients like these day in and day out.  Patients who get prescriptions from their doctor only to have them sit unused on the shelves to be brought to you for refills months after months.  These are the patients who give you a bottle to refill that has 28 out of 30 tablets left in it (but the vicodin bottle is stone empty).  These are the patients who you see the drug dosages increase and increase then switched to something thats expensive (and not covered) only to sit there and expire on them.  We do the prior auths, we go through the filling procedure to RTS them a month later, we send refill requests to the doctors to have them waste money paying office staff to respond to them.  Its a big waste of time and money for everyone involved EXCEPT the patient.

What does a pharmacist do at this point?  Does he try to have a “Come to Jesus” meeting with someone who obviously has no regard for their health?  After all, healthcare is “free” to them, they can just take an ambulance ride to a cushy ER at some paid-for-by-tax-dollar establishment.  Or does he/she see the writing on the wall and just fill the Rx knowing full well it won’t be taken.  We all know that the moment you refuse to fill that Rx they are going to die and you’re livelihood is in jeopardy in some civil suit.

What does an MD do at this point?  Does he/she shit-can the patient only to have him/her die of some complication and get his life ruined by a suit brought upon by the family?  Does he/she write for more medication just to cover his/her ass knowing full well it won’t be taken?  Does he/she waste his/her time filtering the piss out of the ocean when there are other patients out there who need the help?

What does a healthcare professional do when the patient really doesn’t give two shits about his/her own health?  Tough question, no real cut-and-dry answer.  If the patient dies, someone is getting sued; be it me, the doctor, the hospital, someone.  Even if the patient’s family loses the suit, you still have to deal with the mental/financial bullshit that goes along getting sued.  After all, its everyone’s fault but the patient.

A big contributor to this problem is that the patient really isn’t forced to care about his/her health.  Like I said before, the medication is free, hospital visits are free, and the proverbial “You can’t get blood out of a rock” comes true when the bill arrives for services rendered for their irresponsibility.  These patients have nothing but what the state gives them, and have nothing to lose.  So what if I’m 500 lbs and my HbA1c is around what my IQ is, I know that if the shit hits the fan I can go to the ER and get treated for “free”.  Theres no burden/penality on the patients to take care of themselves, and (much like everything in life) the responsible people end up paying the price.  People in other countries would cut their testicles off for just a smidgen of wasted care that is taken for granted here.

I hate to say it, but I think know the healthcare system is going to implode on itself in the next 15 years (if that).  There are way too many irresponsible people sapping the resources that the responsible people produce.  Nobody cares about their health anymore, and the people that do are the ones paying out the ass for services that cost a truckload to compensate for the loss accrued by the irresponsible.

You may think that I’m blowing smoke out up your ass, but take a look around next time you are in a public place at the amount of morbidly obese people are mouth-breathing around.  Look at their kids and the crap they stuff into their face at an alarming rate.  Its not ignorance thats fueling this, its the simple fact that when push comes to shove they will get treatment without payment.  We are afraid to say “You did this to yourself, you deal with it” because of some bullshit excuse like “its not their fault”.  You may think that sounds uncaring and callous, but take a second out of your candyland outlook and look around you at the people who are pissing their health down the toilet on your dime just because they can.

Healthcare is a business, All of us; doctors, pharmacists, nurses, PAs, NPs, and the staff that help us all have bills to pay and families to provide for.  Charity won’t put food on the table, and the sooner you realize this the better off you are.  If you want charity and “helping those in need” then work for free and see how far that gets you.

I hope you link this jaded-yet-true article on your website/forums/whatever, because I’d really like to know how this problem can be fixed/should be fixed or what we can do short of just making as much money as we can before the entire system explodes and we’re all out of work.

Patient compliance is one of those words that’s thrown around pharmacy school/trade magazines like singles at a titty bar.  Its the illusion that you have the ability to make your patients take their medication like they are supposed to.  Yet another concept that looks great on paper/in the magazines but in real life, not so much (gee, sounds like OBRA90?).

Lets look at this from a realistic standpoint.  You have say 500 patients that you fill medication for on a regular basis.  Do you really believe that you can help improve compliance for each and every one?  You don’t even have time to take a lunch, let alone remind the 90 year old Mrs Smith (who’s clock should of ran out a LONG time ago) that she needs to take her water pill?  Why spin your wheels making MORE work for yourself when you can focus on the patients who ARE compliant, who DO care about their medication, and are willing to work WITH the healthcare system vs just wasting money?  Its just a frustrating losing battle – the sooner you realize this the better off you are.

Sure, you can be one of the pharmacist in the APhA magazines who sit and talk with each patient for 45 min about compliance/MTM/unicorns and pixie dust, but after your store goes under (or you get sued into bankruptcy because your bargain basement techs you hired to do the grunt work killed someone) then will you understand that enforcing compliance is a war long lost? Compliance begins with the patient, plain and simple.  They need to choose their level of involvement of their own health and well-being.

Nothing pisses me off more than having a damn intern pharmacist spend 30 min talking to a patient about compliance.  The patient just gets a glazed over look, says “uh huh” a ton and walks out in no better shape EVERY SINGLE TIME.  Patients don’t want to be lectured about their medication, they want to pick up their government-vicodin and go about their day.  PATIENTS DO NOT CARE WHAT YOU HAVE TO SAY UNLESS THEY ASK YOU FOR HELP.  This is cold sobering fact of retail.  Unsolicited advice gives you blank stares and a “mind your own business”.

So what this boils down to is that once that patient leaves the store with their pills they are on their own to take them correctly.  Stop wasting your time with the hand-holding, they are on their own to take responsibility of their own health (foreign concept I know).  If the patient can’t get their pills straight, well, that’s a whole lot of their problem isn’t it?.  My problem is making sure that the 20 different medications don’t kill them.

You all may think that I’m being quite the asshole about the subject (gee, thats a first!), but the fact remains that I would rather spend my not-making-the-store-money-by-not-filling-Rxs time helping those whom choose to help themselves.  Choose your battles or you’ll have nothing but losing battles.  DrugMonkey and I should teach a class at pharmacy schools.

Not only are non-compliant patients a detriment to themselves, but are a detriment to the entire system as a whole.  Say Mrs Madeupname gets some glyburide.  She just blows off the doctor (and your) warnings about not taking her medication and gets a refill every month (that she just stores/ditches) so “the doctor wont yell at her”.  On her next visit, the doctor will see little/no change in her glucose.  Doctor increases the dose thinking the current medication isn’t working.  Or doctor switches/adds Avandia/Januvia/Actos thinking that will get more control.  See where this is going?  Then when Mrs Madeupname finally feels like shit because her glucose is 500 and takes her meds, she bottoms out her now maxed out dosages and ends up in the ER.  Doctor calls you all pissed off and blames you for not making sure she is compliant (but you are quick to point out by her refill records, she /is/ compliant as far as you can tell).  PLUS the moment you question her about compliance she quickly transfers her medication to WalMart who “doesn’t butt into her own business” (good riddance!).  All this for a $2 dispensing fee.

Now lets talk about the patients who ARE compliant:

There are only 2 settings where compliance actually takes place; controlled substances and patients with high copays/no free ride.

Controlled substances is obvious, when the patient takes them there is an immediate physiological reward.  Your pain/anxiety/etc is gone (or you get a good buzz).  This rewards you to take another dose, and another, and bug your pharmacist for an early refill.  You don’t take your medications and there is an immediate penalty (pain/anxiety/dealing with your shitty life/etc).

Folks with high copays are also more compliant because not only do they have to shell out the cash for the medication, but most (if not all of them) don’t have the luxury of a taxpayer funded ambulance ride/hospital stay if their health goes down the shitter.  These patients are looking at multi-thousand dollar hospital stays/ER visits – they have no safety net of the nanny-government to pick them up when they fall.

They should teach interrogation and water-boarding in pharmacy school.  While they are at it they should teach a mind-reading class too.

Yeah, I know I said 2 posts a month, work has been killing me lately (as it does any pharmacist) so I haven’t had much free time as of late.

Anyway,

Freeitude – The attitude that everything in a pharmacy should be “free” because of the past events of a persons life.  Also called Entitleitude, Pooritude, or Douchebagitude.

One of the most annoying shoot-yourself-in-the-face moments in a pharmacy is when a patient who is on a state/county/city funded drug assistance program/welfare gives you both barrels because they have to “drive across town” to pick up a balance of a $200 medication that they are getting for free.  This act of ungrateful entitlement makes pharmacists and their staff wish for a reduction in population, and mandatory sterilization of the people involved.  It also makes them bitter, and have a general hatred for humanity.  The icing on this cake is that these patients are angry at the world (especially you and your staff) like its YOUR fault that they got hooked on drugs/were born stupid/got hurt and cant work/excuse #424 and put into this situation.  Its annoying, very annoying.

I mean seriously, if someone offered to give me something worth over $200 for $0 (hell, even $5 or $10) would I get pissed off if I had to return the following day to pick up the rest of it? Fuck no! I’m getting $200 bucks worth of goods for nothing!  I’ll gladly return with a smile on my face, a huge thank-you, and an appreciation that cant be measured.

The amount of bitching these patients do about their meditations also lowers my outlook for my fellow man.  Bitching they only received a Lumigan 2.5cc bottle instead of a 5cc bottle (you look up how much Lumigan costs) is like getting upset because the state gave you a black corvette instead of a red one.

Sometimes its not even the constant drone of complaining/whining/bitching these patients bombard me with on a daily basis, its the lack of basic courtesy.  I expect a “thank you” after I save your ass from a drug interaction or getting that prior auth which your doctor would have never obtained on his/her own.  Instead I just get a complaint how I don’t have that $1000 special-order drug in stock even after I told you to give me a week to order it.  Its like I’m expected to be everyone’s mom/dad/babysitter and forget that the sole reason why I am there is to protect you from dying because you’re an idiot with your medications.

Now if you are paying cash for your medications, then you have the full right to bitch at me (as I have the full right to increase the price of your medications the next time you come in), but getting shit for free? Sorry, you have absolutely no room to bitch.  You are getting a handout from the generous taxpayers in your area, be grateful that we are forced to care for you.

Let me put it bluntly; If pharmacists weren’t around, you would of died by now due to a drug interaction or be dead from not getting the proper medication.  We save lives on a daily basis, and no matter how fucked your day/life/etc has been WE are not at fault, so show us some fucking courtesy like your dead-beat parents should of taught you and stop yelling at me for shit that’s 100% not my problem.  Go bitch at the EMTs for putting the IV line in your left arm instead of your right arm while you are bleeding out after that drunk driving accident instead of us.

All of this for $2 dispensing fee.  The kid who vacuums my car at the car-wash makes more in a tip than I do off of your Rx.

Ive been writing on this site for almost 5 years.  I’ve noticed a few trends come and go.

1. Any post about crackheads instantly bring 100 page comments from legit pain management people explaining how they are not a crackhead.  This is besides the point that I make it very clear in said post what is (and is not) considered crackhead behavior.
2. Any post about crackheads instantly bring 100 page comments from crackheads justifying their crackhead behavior.
3. Students know absolutely nothing about the ‘real world’, except nursing students who know double-nothing.
4. The most common crackhead response is that we are a bunch of meanies, and are going to be replaced by machines.  Legit pain management patients don’t share the same views (go figure).

Lets look at the ‘replaced by machines’ scenario, bring some non-hydrocodone influenced logic to this and how awesome it will be for the average crackhead and patient.

Imagine there are no more pharmacists.  Your doctor gets his little PDA (or whatever) out, punches in the drugs, and zips it away to some super-mart with a eFill-4000 just humming away.  Lets just ignore the fact for a second that doctors cant send eRx’s correctly to save their (or yours!) life.  The eFill receives the order, and processes it along with the 50 other orders it has lined up.

You, crackhead, smugly happy that there are no real-life pharmacists any longer punch your refill in via the telephone, and stumble your way to the super-mart to visit your BFF eFill.  You put your thumb on the little pad, type your 4 digit code, and here is what you get.

ERROR: RX 459534 – LAST FILL WAS 6 DAYS 23:19:15 – CAN BE FILLED IN 0 DAYS 0:20:45.    PLEASE RETURN THEN.

(Yeah, the math is probably wrong for the days, I don’t care, you get my point)

Damn, 20 min and 45 seconds too early for your 30 day supply.  See, a human pharmacist would of just looked at the day, saw 30 days had come and just filled it.  Hell, you cant even get all pissy and argue with a robot!

Here are some more likely responses one might see:

ERROR: RX 4593823 – MD AUTHORIZED 4 DAYS EARLY FILL ON 2/24/10 – ADDITIONAL REFILLS PUSHED BACK 4 DAYS.

and

ERROR: RX 492343 – FEBRUARY ONLY HAD 28 DAYS.  PLEASE RETURN IN 2 DAYS.

I think you get the point.

How about the doctor decides to write you some blood pressure pills.  He sends it over to the eFill and tells you to pick it up in about 3 hours.  You arrive with your crisp $0 bill in hand for your state-covered copay when you read this message:

ERROR: RX 5393834 – PAYMENT DUE $234.00 – PRODUCT/SERVICE/NDC NOT COVERED BY INSURANCE (MEDI-CAL) – CONTACT PROVIDER FOR ALTERNATIVE OR INSERT CREDIT CARD.

Damn, because your insurance company doesn’t spit out what is covered (thanks Medical!) you’re left in the dark to decipher what is covered and what is not.  You don’t even have a helpful pharmacist to guide you in the right direction.

As the late Billy Mays used to say, BUT WAIT, THERE’S MORE!  You have really bad CHF.  To the point where you’re huffing and mouth-breathing to walk to the back of the mega-mart where the eFill is at.  Dr said he wants you to take something about an hour before you take your lasix.  Here is what you get.

ERROR: RX 4938532 PENDING FOR MD OVERRIDE – THERAPEUTIC DUPLICATION OF FUROSEMIDE AND METOLAZONE!

Isn’t technology grand?

As any pharmacist will tell you, there are a metric buttload of “interactions” that flash up on our screens.  About 1 in 40 are actually real-life interactions, the rest are just theoretical interactions that we have to override because lawyers reign supreme and nobody wants to get sued for “not telling us”. Only through the use of our SCHOOLING can we determine if an interaction is legit.  One interaction may be a non-issue in patient A, but its a huge issue for patient B because of drugs XYZ and surgery A.  You think the Doctor is going to keep up on interactions? HAHAHAHA *ahem*.  Doctors have a hard enough time using eScripts, lets not get carried away here.

There are just some thinks that a robot cannot do well, abstraction, application of unrelated data into related data, and fuzzy logic judgment.  Think of it from another angle: we have the technology with high-precision GPS systems, optical sensors, and super-fast computers yet we don’t have cars that can drive themselves.  We have cars that parallel park themselves, we have cars that alter the cruise control to avoid rear-end collisions, but they both require the judgment of a HUMAN (on a FUCKING CELL PHONE) to pilot safely.

Since I used the word ‘crackhead’, cue the 100 page comments about what part of your spine is fused together, all of the medication you are taking, and how I shouldn’t be a pharmacist.  I’m not going to point out the title of this site, because obviously basic reading comprehension went out when the hydrocodone went in.

Think of this senerio:

The owners of 3 independant pharmacies go out for dinner.  During the dinner they talk about how (for a very accurate yet hypothetical example) low MedImpacts MAC’s are compared to other insurance companies.  During the discussions they rabble on about how they cannot do business at COST + $0.75 and jointly decide to fax their contract termination letters into MedImpact.  That, right there, violates the Anti-Trust laws.

Now think of this:

CVS/Caremark (a pharmacy/PBM merger) decides that MedImpact doesnt cut the mustard.  They threaten to terminate their contract which will effect a couple hundred stores.  MedImpact tries to play the hero and refuses to negotiate, and now 300+ stores are off of MedImpacts provider list.

Three independent pharmacies get dinged for Anti-Trust behavior, while CVS/Walgreens/Rite-Aid(?) can nix hundreds of their stores without violating anything.  Tell me if that was the intent or spirit of that law.

Since we’re talking about the exploitation of the Anti-Trust laws that were made to protect citizens from such behavior; lets take CVS/Caremark.  Now a while ago we (meaning every independent in town) underwent a Caremark audit.  Now considering those auditors are paid by the infraction, and they will cancel out any prescription that was written for tablets but filled will caps (even if the medication did not come in cap dosage form) among other totally bullshit non-fraudulent-act (like the MD instead of the NP checked off), do you really think CVS gets held to the same exact standards by Caremark as us non-CVS stores?  Have you ever thought about how shady and corrupt a PBM looks taking money away from the direct competitors of their affiliated pharmacy (probably in a futile hope of putting them so far under they will sell out to *their* affiliated Pharmacy chain)?   CVS Pharmacists: Do the Caremark auditors come into your store and audit your records?  Since you’re affiliated, aren’t they just taking away from themselves? Or do you guys write off the store losses by filling ‘fraudulent prescriptions’ thereby making your store less profitable and thereby pay less taxes?  Marvel at my TinFoil hat and how its shiny!

I wonder if Medco audits its mail order pharmacy, god knows they love to audit us independants.  I wonder if all of the big PBM/Retail anti-trusters have some sort of unspoken fraternity-boy truce going around leaving the independants/grocery-outlets/walmarts on the audit chopping block.

Naaaaah, that would be in violation of the anti-trust laws that prevented 3 small pharmacies from speaking out against a dont-give-a-shit-about-you PBM.

There is an inherit problem with having zero copays for our “less fortunate” friends.  Lets look at two cases.

Mary is a 35 year old single working mom.  Her ‘baby daddy’ left her high and dry when the going got tough.  By using daycare through her family, she is able to pull off a part time job and qualifies only for food stamps.  She is not eligible for full-scope welfare due to the inherit racism that goes on within the welfare system (yeah, I went there, ignoring it wont make it go away).  She forgoes the fancy cell-phone, cable-tv, and nice car to afford health insurance for her and her baby (which shes fine with, she views insurance as a necessary expense like food).  Her copays are $50/rx.

Jacob is a 45 year old male.  Due to heavy cocaine use during his youth he has congestive heart failure and as a result is unable to work (according to him and his quack doctor).  He recieves full-scope welfare complete with food-stamps and a check every month.  He spends his day harassing his pharmacy about refilling his pain-pills early and enjoys watching daytime TV.  His copay is $0/rx.

Both Mary and Jacob bring you an Rx for some Flovent.  Mary pays $50 and Jacob pays $0 for the same Rx.  Both leave your store drugs in hand.

A week later, Jacob calls you and says he lost his Flovent.  He has spend a whole 4 min’s looking for it and demands he gets a replacement at once.  Mary also calls you a week later.  She has torn her entire house apart looking for this Flovent and is reluctant to ask for a replacement Flovent at the cost of about $175.  Jacob is upset at YOU that the insurance wont pay for it early, and Mary is upset at HERSELF for losing something that cost her $50.

See where this is going?

There is a HUGE problem with giving people medications for free.  The problem is that once something is free, people see no value to it.  Sure Jacob lost a Flovent or Blood Glucose Monitor, but because to him its free, why should he spend any of his valuable time to actually look for it vs just calling and getting another one for free.  Mary has an incentive to tear her house apart (or call her insurance company) looking for the lost Flovent because it COST her $50.  Jacob is out nothing, and Mary is out something.  Jacob gets everything handed to him while Mary busts her ass.  Both are “in need”, but their reasons for being “in need” is another rant for another day.

Mary obviously places a value on her Rx’s.  Even if shes oblivious to the true cost of the medications (and how much her insurance company pays), shes quite aware to HER cost for those medications.  Jacob, on the other hand couldn’t care less how much his lost medication has cost the state because HIS cost is a whopping zero.  Who cares if he lost every medication on his profile in an act that was entirely his fault, he’s out nothing short of the inconvenience of driving to the pharmacy and picking them up again.  He wont have to choose medication or rent, and his check wont be impacted in the least.  Mary isn’t so lucky.

Lets put it this way; by getting drugs for $0, there is no negative-feedback/punishment/repercussions for losing medication.  Medication has a net-worth of $0 to them, and they don’t give two fucks what happens to their medication because their lives are not financially impacted by losing them.  If I spend $50 on something, and I misplace it, I’m sure a shit going to tear everything apart looking for it.  Is it the same if I spend $0 on something?

Think of this next time you fill that ER prescription for Tylenol and Robatussin DM.

Sorry for the lack of updates.  Between vacation, work/life, and lack of good and funny rants things have been sorta slow here.  I intend to fix that for 2010. One rant twice monthly if it kills me.  Too many posts don’t get the awesome comments, and too little makes people lose interest in the site.  Twice a month is a happy medium.

On with the rant!

As you all well have known, we are in 2010 and we are one week past the dreaded first of the year mayhem.  If you are a pharmacist, and have not died from alcohol induced liver failure you obviously have first hand experience about HealthNet (Or their processor, CVS/Caremark) screwing up SO bad that I can’t even believe that they are still in business.

For those not “in the know”, lets set a few things straight so people don’t get confused.

• You have Medicare + Medicaid
  • You have no deductible (of usually $250 – $300 depending on plan)
  • You have little to no premiums
  • No doughnut holes (ie: the coverage gap)

Pretty much if you are on the state tit because you cannot take care of yourself, you get all the benefits of a Medicare part D plan without the annoying doughnut hole, deductibles, and screaming high copay tiers.  Nice isn’t it?  The rest of us however have the initial deductible, blah blah blah.

Now, lets rewind to HealthNet’s Medicare part D plan oh, a week ago.  At least in California, NONE of the “Dual Eligibles” (the people with Medicare AND a state welfare insurance) were flagged in HealthNet’s computer system as being on a state welfare program.  Which means that almost all of the people who should of had NO deductible suddenly got one (with a $200 copay for their Advair)!  Compound this with the usual first of the year plan changing clusterfuck and you have yourself a 2 hour hold time with HealthNets pharmacy help desk!

Oh, lets not forget that HealthNet also didnt flag generic Vicodin and Septra DS as being covered items.  So for one insurance company, we have a shitpot full of welfare-recipients pissed off at us because “we” want to charge them more than $1.10 or $3.20 AND their vicodin is no longer covered.  So whats a pharmacist to do?

Easy.  Let the fucking patient get off of their asses and take care of it themselves.  Why should we have to suffer the fallout because some computer idiot over at CVS/Caremark (which I wonder if CVS pharmacies had this problem) totally fucked up the data import from California MediCal.  Yeah, I’m a heartless asshole but I’m tired of being the human fucking shield for these PBM’s who make more per prescription than I do.  What happened with HealthNet was completely unacceptable and embarrassing.  Of course HealthNet/CVS/Caremark will continue to collect their fat ass subsidization checks from California as they tinkle in our faces with their whopping $3 above cost reimbursement.  Here me now HealthNet, unless I see some MAJOR lawsuits from you to CVS/Caremark over this bullshit, I will do everything in my power to switch my Dual Eligible patients to any plan that is not administered by you.

Oh, and just icing on the cake, I got the fax yesterday evening from HealthNet that everything was fixed.  Thats 8 days of chaos due to  a company that makes more in 1 week than I’ll see in 10 years.

Post your hateful HealthNet comments (or funny first of the year stories) and lets see if I get a response from them (and hopefully not a C&D letter).

Copays.

Probably the most confusing and frustrating concept in the pharmacy world.

The idea is simple.  You pay the pharmacy money to help pay for your drug, hence the word Co-Pay.  Like Cooperative Pay, you and your insurance company are joining forces to pay the pharmacy for the goods given to you.  If it were that simple then I wouldn’t have a website.

When I hear that I’m needed out front because a patient has a question about a copay, my GERD goes through the roof.  Not because the concept is hard, but I know that I’m going to get yelled at and blamed for something that is 100% not my responsibility, not my fault, and to be honest a whole truckload of not my fucking problem.  I’m a pharmacist, I make sure drugs don’t kill you, I don’t give a fuck about an issue between you and your insurance company.  Your insurance company says I need to collect $x, so the bill is $x.

The most frustrating (and that requires the most restraint on my part) is when people bitch that their copays got bumped up from $5 to like $15 for shit like Aciphex, Nexium, or some other drug that costs over $100.  I really have a hard time not taking their prescription back, running it out as cash, and saying “here ya go, pay that now you ungrateful stupid fuck”.  These people are stupid, and really dont get the concept that they are getting $150+ worth of medication for $15.  “I pay premiums I want my insurance to pay for all of it!” says the idiot who is getting about $500 worth of medication totaling $50 worth of copays with $200/month premiums.  You are getting MORE OUT than you are PUTTING IN and BITCHING ABOUT IT!!!! No wonder why this system is all broken.

Idiots on socialized plans (Medicare/Medicaid) are even worse, because their copays are like $3.10 which is MORE of a slap in the face when they bitch/cant pony the cash for their $200 worth of shit they probably don’t need.

Enbrel, $3.10 copay, cue the massive whining and bitching on how someone is on a “fixed income” and cant pay.  Enbrel is thousands of dollars for $3.10.  Three fucking ten.  You cant even buy a fucking value meal at McDonalds for $3.10!!! This fucking twat is whining at me for having to pay!!  I’m sorry honey, but that $3.10 is my whole profit from this Rx, so I’m not letting you pay me on the first.  Personal finance 101, make sure you have $3.10 for your Enbrel – Thank you.

I mean really, if you went to go and buy a TV at Best Buy that costs $400, and you threw a fit because you had to pay out of your own pocket $25 for this $400 TV, would you be upset if people called you stupid?  Would you be upset if the salesman said “Listen you fucking idiot, the rest of the world has to pay a whole fuckload more than you, and you’re whining about a measly $25 for a $400 product?!?”

Then there is this bullshit rumor that we set the copays.  If pharmacists could set insurance copays, then maybe the bitching and whining would have some merit.  However the HUGE FUCKING NON-SECRET is that PHARMACISTS DO NOT SET YOUR COPAYS (unless you are paying cash).  They are transmitted to us via computer and are set by the insurance company that YOU PAY (or we pay) TO PROVIDE YOU Rx COVERAGE.  Does the Taco Bell drive up teller set the price of your burrito?  NO! They punch a burrito into the computer and it spits out how much you need to pay.  Pharmacy is the exact same fucking thing, but people still don’t get it.

People want something or someone to bitch at because of their copays.  Yeah, that’s fine, but bitch at some Indian drone at Blue Cross, not me.

Here is my outline as to what could be the perfect socalized will-fail-less government subsidized medicine plan.  Since obviously this is going to be passed riding on the coattails of the H1N1 fear and panic machine, I could at least throw in my $0.02 as to how this is to be laid out.

Now before you read this, remember years past when WalMart came into town?  How they used their huge might to pretty much crush any competition in the area with “low low prices” all while shitting on their employees and being an all-around shitty store with poor service.  Now considering this government plan has the financial backing of every taxpaying man and woman in the nation (regardless if they want to or not); think of Walmart as your cushy retirement insurance plan goes bankrupt and you’re forced to enroll into a government ran plan.

The Angry Pharmacist Socialized Health Plan Solution

By: The Angry Pharmacist

http://www.theangrypharmacist.com

Here are some nice and easy (and unrealistic) points that this new government funded (with freshly printed money/stolen from the working class) health plan should have:

• No trade name drugs are covered.  No exceptions.  Prilosec/Protonix doesn’t work for you? Tough shit.  Cough with ARB? Too bad.  None of the trade name medications would be covered.  The government needs to eat its own dogfood (or practice what it preaches) and only does business with companies that drive down the cost of medication (ie: generic companies).  That expensive chemo drug not covered? Then let the government use taxpayer dollars to buy out Amgen so they can give it out for free (why not, everyone else got bailed out).
• The plan is voluntary.  If you wish to be a part of Obamacare, then you get the premiums deducted out of your gross-pay.  If you wish to have private health care, then you won’t be dinged a dime for Obamacare.  I’m not paying for all of your PacifiCare and Blue Cross plans (and your insurance premium dollars dont pay for my private insurance) so why should I have to pay for someones Obamacare?  The chances of this happening are as likely as you buying the nice bridge I have for sale.
• You get 4 doctors visits a year with no/low copay (say, $10).  Every doctors visit after that has a $25-50 copay.  Yeah, it sucks for the people with chronic conditions like diabetes and stuff, but its better than nothing.  Don’t get the unlimited text messaging plan and you can afford your doctors visits.  Don’t order a large pizza and you can afford another doctors visit.  Wait, actually becoming an active part in my health? What is this witchcraft you speak of!
• You get 1 $0 copay ER room a year.  Every ER visit after that is $100 minimum.  I’d like to see this figure raised to $250 or higher since ER is for……. EMERGENCIES!  You know why the ER rooms are so packed? People view them as “Free”.
• Since all Rx’s will be billed to the government, if you are on a maintenance medication and you are non-compliant, guess what, your premiums just went up unless YOU (not your doctor, not your pharmacy) can submit documentation showing that you were taken off of that drug, or switched to another one due to intolerance.  Whats the point of the government dumping all this cash into your doctors visits and medications if YOU are TOO LAZY to do anything about YOUR CONDITION.  Not taking your medication is just pissing away money.  No matter how many times I bitch, your doctor bitches if you don’t want to take your medicine then you can get dinged in the pocketbook.  True this can be thwarted by people just picking up their regular drugs and not taking them, but it might make a few people think twice before asking for medication they have no intention of taking.  Cue the “Waah, we don’t want the government poking its nose into our lives” as they happily promote Obamacare.  Wait, are you confused?
• If your doctor kept up to the standard of care, then unless his peers can show an act of negligence, you cannot sue him/her for 1.4 zillion dollars in a huge malpractice suit.  Lets face it, without your doctors care, you would have died a long time ago.  We don’t need your doctor running up the bill with 400 lab tests every damn office visit out of fear of getting sued if he/she happened to miss something weird.

Now on the surface, this plan looks pretty damn shitty.  However we have a fundamental problem in this country where we want privatized health-care at socialized prices (ie: Free).  Not going to happen, actually it can’t happen!  Look at MediCare and how broke it’s becoming!  No seniors bitch about Medicare (doughnut hole), because they are so (doughnut hole) happy about the coverage (doughnut hole) that it provides (doughnut hole).  Did I mention that the government had to implement the doughnut hole to keep the Medicare system from going completely broke?  Did I also mention that we just slapped Rx drug benefits on top of an already stressed system like an idiot taking a 4th mortgage out on his house to buy a boat then wondering why he can’t make the payments.  Should I just ignore the point that before Medicare part D came out, seniors on MediCare were paying cash-money for ALL of their medications and were doing just fine on all generics?  It wasn’t until the government decided to “feel sorry for them” and slap on a part-D plan that they became greedy and wanted trade name shit (all for no copays).

If health plans were cars, this would be the basement model with no A/C, manual transmission, manual windows/door locks, and it pretty much just gets you where you need to go.  This would be the ideal solution.  It gives people the basic care they need, and to be honest if they wished for a plan with more bells and whistles then some most-costly private plans could do them well.

Oh, but wait, we all want our cake and eat it too.  Mark my words, this plan will give people an inch when they want a mile, and short of the entire collapse of the healthcare system, the public will just want MORE for LESS.

I’d like my bailout in 20′s please.

Sometimes I wonder why we even listen to what patients have to say.

How many times a day are you lied to by a patient.  A patient who on the phone will tell you they “lost” their medication, but when they magically show up at the store they say they are going to Mexico for 2 months. A patient who cried how his pain pills were stolen 2 days ago, yet is in the paper today for selling his prescriptions to an undercover officer.

Heres a colorful metaphor.  You have two sparkling clean containers (the doctor and the pharmacist).  One is filled with clean pure drinking water (the message) and must be moved to the other container.  How we join them? A piece of uncleaned retired sewage pipe (the patient).  Sure, water is going to get from one container to the other, but its going to pick up a whole lot of shit along the way.  However heres the kicker, some doctors listen to what these patients have to say as the absolute truth.

Example:  Doctor calls up the pharmacy pissed as hell because the patient said that the “bad pharmacist wouldn’t fill my pain pills”.  Doctor gives the pharmacist both barrels before being fed some humble pie by learning that his beloved patient got a month supply a week ago from another doctor.

Patients are horrible translators, historians, and message carriers.  How many times has a patient told you a message they recieved from the doctor (like to stop a medication), only to have it be horribly wrong?  How many times have you had patients spout medical jargon they learned from their doctor about their condition only to have it be sorta right in a ignore-the-big-picture sort of way?  Yet doctors and pharmacists use the patient to carry messages to each other.

“Contact myself or your doctor if your lisinopril gives you a bothersome cough” turns into “My pharmacist told me to stop my lisinopril because I coughed” and “Maybe you should ask your doctor about a pain management referral” turns into  “My pharmacist said that you should send me to a pain management doctor because you don’t know what you are doing”.  The shit that patients twist and fabricate with a single grain of truth just boggles my mind, and just makes bad blood between the doctors and the pharmacists.

What kills my soul (which a lot of things do, this being one of them), is when patients have a tiny-yet-dangerous bit of medical knowledge gained through the internet or one nursing class 15 years ago.  Then the bullshit they spout actually sounds like it really did come from the doctor or pharmacist even though its completely wrong.

So how to handle this?  Easy, treat the child like he’s a fucking 5 year old, and pin a note to his/her shirt to give to the doctor/pharmacist.