We're All Out of a Job

Sunday I posted about my adventures in nabbing several people abusing the system. I neglected to mention, namely because I didn't see it to be relevant, that I was filing in at a store for the day.

I stopped by there today to grab something I left, and while there I explained everything that happened to the techs who normally work there. Their response?

"Why would you do that? That's less prescriptions for us to fill every day which means we could eventually lose our jobs when they close our store for our low numbers."

First off, this place is by far the busiest store I work at, so that's not even a remote possibility.

Second, are you fucking kidding me? I help nab people who are abusing the system (ya know, the system we all pay for through taxes) and are breaking several laws, and you get pissed at me?

Thank freakin' God I will be done working for this company in two short months. Would you put up with that kinda crap on a regular basis?

Advair... In A Provocative Position

Slow day at work today and someone left their Advair diskus here. Naturally I decided to act like a five year old and crack her open to see how she works.

So if you ever wanted to see the innerds of an Advair Diskus... today is your lucky day.

A Good Day In The Pharmacy

I had one helluva of a productive day during my Friday shift. I nabbed four, count them, FOUR seekers in one day, all in separate circumstances.

It had been a rather dreary stretch as I hadn't come across anyone worth busting in about four months now. Personally I like doing a little PI work at work, makes me feel like Matlock... you know because of all the old people and fixodent in the store.

My favorite is I busted someone who has been using three different docs with three pharmacists for at least seven years. I went to bill her fioricet and it came up rejected as an early refill which was weird because she wasn't early at all.

The insurance in question has a knack for giving false rejects, so I figured I'd call them and have them fix whatever the fucked up this time.

Oops.

Turnout one of her pharmacies auto filled her fioricet under her insurance on accident on the sixth. As I inquired more I found out about the other pharmacy and doc.

Ruh oh.

I call pharmacy number one and they talk about what a sweet lady she is and that they hoped she wasn't transferring out. Needless to say they were more than a little surprised when I explained the situation.

Pharmacy number two was a big chain who didn't seem to give a rat's ass, which is somewhat typical around here.

You guys wanna know the best part? She had a narc contract too. With TWO docs.

How the hell she had pulled this off, I have no idea, but I give her props. Sadly, there will be no more fioricet or tramadol or hydrocodone or phentermine or any other fun things.

I suppose the best part is she really has no idea until her appointment next Monday... when there will be a phone conference with three very pissed off docs.

Damn I wish I could be there for that.

And that was just one of the four today. Like I said, it was a bitchin' day all day long. Maybe I should start a secondary business some day.

Phathead, R.Ph. - Private Eye

It's got a nice ring to it, no?

I Want To Be A PBM.... So I Don't Have To Pay Taxes

I can understand why PBMs reimburse us mere pennies above cost. I can, somewhat understand why they refuse to pay fees.

What I do not understand, however, is why they refuse to pay the tax on a drug.

You see in one of the states I have worked in, I keep tabs on my prior employers, many of the PBMs have decided they will not pay for the state tax on the prescriptions we fill. They leave it 'up to the pharmacies' to deal with as one kind PBM rep told an ex-coworker of mine.

The kicker is according to that particular state law, the PBM has to pay the taxes enforced by the state. Yet some how, they're allowed to get away with not paying it.

They are then left with the tax amount and are forced to make the patient pay for it. It is not something that normally I would condone, but seriously what else can you do?

My question is how is this acceptable? Several of the patients who have asked why this has happened have been completely livid with their provider. One of which, apparently, left his work plan and opted to go to a private plan instead.

Apparently if you are a PBM you can get away with no paying taxes. You know what would happen if I chose to not pay my taxes? Well let's just say I may be sharing a tiny room with a guy named Bubba and a lack of Astroglide at night.

So I have decided, on this glorious spring day, that I will now be a PBM instead of a pharmacist. Judging from experience, I will be able to boss everyone around and not have to do anything that I don't want to do. The money I earn will come at the expense of those around me. This, of course, includes when logic stands in my way.

And of course, I will be free of paying taxes. Because, damnit I won't want to. And since I'm a PBM, if I don't want to do something, I don't have to do it.

Right?

Oxycontin is... What?

"So just to clarify, he has a morphine allergy and I want to make sure you're giving him Oxycodone ER instead of Oxycontin because it has less morphine in it"

**Crickets**

Ok, now that you have probably read that three or four times, I will start by saying, What. The. Fuck.

It took me several explanations for me to explain to her that Oxycontin and Oxycodone contain no morphine in it. She kept reiterating that her computer software was telling her that the morphine allergy was triggering a 'big warning' about an allergic problem to Oxycodone. Thus, she said, Oxycontin must contain morphine.

This was from a CNP out of a major hospital working through a major pain clinic.

Ok ok ok, I'll ask the question the rest of you are already asking in your head.

HOW THE FUCK DO YOU FIGURE THAT MORPHINE = OXYCONTIN???

I mean seriously. I can understand maybe not knowing what Kadian is or something because it is relatively obscure, or at least is so in my area. But how in the hell do you not know what Oxycontin is?

I could ask any crackhead on the street what is in Oxycontin and they would answer correctly. It is one of the most used, and probably most abused, C-II narcotic on the market.

And you don't know what's in it? And you PRESCRIBE for it? And you work in a PAIN CLINIC?

Are you fucking kidding me?

To be fair, she was a rather sweet CNP, but I don't think I can excuse something like that. She wasn't new either, she eluded to the fact she hadn't been in school for quite sometime.

I'm just in shock, utter and complete shock. Anyone else see a problem with this?

I'm A Daddy... Kinda

One of the agreements the wife and I came to when discussing moving is how we would move to an apartment that allows pets. Our current apartment does not allow pets, and we both have wanted a dog for some time. Thus, one of our first purchases upon moving would be a dog.

Oops.

Meet River. She is about eight weeks and is half shih tzu, half maltese. Her name comes from the show Firefly (probably the greatest TV series to be canceled after two months) because we're both nerdy like that.

She is also, at this moment, an illegal alien. We did not plan to get a pup this soon, but really, could you turn down a face like this?
So for now she is hiding, every so quietly, in our apartment. I figure if Old MD Girl can show off Boo, I can show off little River.

Maybe we should open a debate over who is cuter. Muhahahahahaha.

Studying Pharmacy

One of our fellow pharmacy blogging cohorts has turned his focus towards another endeavor. He has created a website designed to help those new to the pharmacy game learn some of the basics in names, calculations and the likes.

It's actually rather slick system that I'll be presenting to my manager on Monday for use in training new employees. For those of you starting out, or for those who want a head start, I figured it would be beneficial to spread the world.

Enjoy!

A Notice To All Doctor's Offices

This is announcement regarding pharmacy etiquette and its relation to all those who work at a doctor's office:

I will be plain as day when I state this. To all of you who work at a doctor's office, if you continue to tell patients that when you send a prescription, it instantaneously is sent to the pharmacy and the prescription will be ready when they get there, I will personally visit you with a 60 dram vial full of Klor-Con and beat you over the head.

I realize the majority of you are probably a bit unaware of how the transfer of prescriptions work between offices, so lets give a brief overview. If you fax something, it ends up in a queue with all of the other faxes in the office because there are only so many lines dedicated to faxing. If you send an eRx it is quicker, but is still not 'instantaneous'.

Even taking this into account, to suggest that the world will stop when this patient's prescription arrives in our store and we will work double time solely on that prescription to get it ready for said patient is utterly ludicrous.

This latter part should be common sense. You know how busy you get, so you should be able to derive how busy we are. If not, take a jaunt down to your local pharmacy in the middle of the day and observe. It may prove to be an eye opening experience for you.

Technology has greatly sped up various processes in our lives, but nothing is 'instantaneous'. If you continue to make such factious guarantees to your patients, we will respond by doing the same to you.

So when that patient comes in asking their Lortabs, we can just as easily tell them that it's been sitting on your desk from the moment we hit our little fax button and they can check with you to see if its ready. And that when you call, you'll be the one to answer the phone because you're eagerly awaiting their phone call.

Now wouldn't that be fun?

Vial Inadequacies

Apparently we had a rather well endowed vial in the pharmacy today.


To say that the other vials were jealous may be the understatement of the year. I know I felt more than slightly inadequate when I saw it. I mean surely, it must have no problems finding female vials with his... um condition.

I named him Peter North and marveled at his... achievement? No... birth right? No.... endowment all throughout the day.

And I thought you all should as well.

I Remember When...

I think one of the defining characteristics of growing older is an increase in using the phrase "I remember when..."

I concede that I am not truly that old, I'll hit the quarter century mark a little less than six months from now, but I still find myself uttering that phrase on a more regular basis.

For instance, I stopped at a gas station a short while ago to grab a bottle of Diet Dew because its one of my vices in life. When the clerk told me the total I did a bit of a double take. $1.84 for a 20oz bottle of pop.

Instantly I texted a friend of mine, "I remember when we sold these for 90 cents each when I started working...." and then I stopped. I realized what I had started to say and how I had started to say it.

My god, I'm growing old.

Sure I have gray hairs now. Drinking more than six beers in a night will usually cause me to have a wicked hangover the next morning. My days of downing several liters of Mtn Dew per day are done because of the heartburn it gives me.

This was seriously a new level for me though. Sure I watch the Golden Girls from time to time (a hilarious show if you neglect it) and maybe I like vegetables more than I used to. Choosing to eat a salad over a burger for lunch doesn't make me old?

Does it?

I suppose I shall have to go buy some Polydent tonight. And maybe watch Matlock when it's on later. And then eat some prunes. All before I go to bed at 4pm.

Sound like fun?

Life Is Sweet

The next two months or so are going to flat out rock. All I have is one measly course to deal with the rest of the semester, so I have no worries about school. I'm working roughly 40 hours a week and will finally pay off some debt with the extra cash I'll be making.

Most of all its my upcoming travels and events. Within one six week period I will:

• Go see Craig Ferguson's stand up show that has been touring the country
• Go see Conan O'Brien's tour as it cuts through our area (got damned lucky with tickets)
• Go to my first MLB game in several years
• Spend a week in Vegas at my best friend's wedding
• Go to my brother's high school graduation

Some of those events are on back to back nights as well. I will spend a bit of money, do a bit of traveling, but it will be flat out awesome.

I can already tell y'all are jealous. And you should be. Muhahahahahaha

How Do You Like It?

As I end a nine hour shift tonight, the pharmacist and I pondered a question. You see over that nine hours we have filled precisely 17 prescriptions.

A daunting number, I know, but it left us with this question.

Would you want to work a nine hour day where you fill just 17 prescriptions or a day where you fill 317?

I'm of the camp where I would rather fill 317. I thrive in chaotic situations and love when its busy. Granted you can be worn out at the end of the day, but at least I do not get bored. And I hate being bored.

The pharmacist on the other hand preferred doing just 17. Her logic was that she did not like when it was overly busy and preferred slower days when she can surf the net or do CEs.

So I pose yet another question to you loyal blog readers, which do you prefer? A day filling 17 scripts or a day filling 317 scripts?

The poll, as usual, is located to the right of the page. Happy voting!