Thursday, February 26, 2015

A Quickie From The Mailbag.

Hi there,

My name is Judy and I'm with the American Recall Center. I came across your blog while researching health safety topics and wanted to say that, as a fellow advocate, I admire your passion for keeping your readers informed, and healthy.

With Patient Safety Awareness Week around the corner (Mar. 8 - Mar. 14), we want to bring attention to a hidden safety hazard found in all of our own homes, our medicine cabinet. It's so important that we understand the medications we take, how to store them securely, and dispose of them properly. That's why we're asking influential writers, like you, to share their thoughts and experiences in a post.

We want to highlight some important facts about medication safety and we're hoping you'd be willing to help us in doing so!

Please let me know if you'd interested,



Dear Judy,

Strike 1- Use of the word "passion." The new definition of "passion" is "empty buzzword thrown randomly into business jargon"

Strike 2- Exclamation point! Another trendy corporate grammar tool to show how "outside the box" we are!

Strike 3- "Inspire?" Really? What....the......? that is actually worth three strikes all by itself.

The answer is no. Please become very passionate about staying as far away from me as possible!

The word that goes here is sincerely.


Tuesday, February 24, 2015

A Question Looking to Be Crowdsourced By You CVS Chain Slaves

This one showed up in today's mailbag, and here are those out there who know more about this than me:

I recently had to write about a CVS case that talks about the DUR system. After reading your blog, it seems like you are very familiar with it. I have one question for you: Are these “hard stops” exclusively managed by pharmacists? Or could some of them (the silly ones) be handled or “overwritten" by a trained technician? I mean, could some of them be managed by others and then the hard ones, only be handled by a pharmacist? That way pharmacist be more focused on the more important ones.

As a former Rite Aid chain slave, I know we had to override them all, and there was *something* to override on almost every prescription. (Caution using birth control in reproductive age women was my favorite.) Not sure if CVS is the same way.

Thursday, February 19, 2015

Pharmacy Jesus Saves Another Pharmacy Soul

From today's mailbag:

It's been a year since I left CVS behind, in part due to your incisive, honest assessments of the debilitated state of our profession. I now work in a nursing home pharmacy with some of the best people you'd ever want to meet in a sweet little town in the scenic north Georgia mountains. My stress is gone, my arrhythmia is much better, I'm a better husband and father, and generally a better person for leaving that toxic environment. I think for all the complaining retail pharmacists do, I don't think they realize how bad it is until they get out and see how good life can be again. Thanks again and keep fighting the good fight.

Crucified and resurrected my friends. Curing stress and arrhythmias. Making you a better person with a happier life. That's what I do. I'm Pharmacy Jesus.

And I'm waiting for you, Mr. or Mrs. Walgreen's pharmacist just home from a 12 hour shift, your hands still shaking as you reach for the scotch and the Prozac, to come join us. It is doable. You do not have to live like this. 

Your liberation starts here

Tuesday, February 17, 2015

Oh, How I Have Been So Dreadfully Wrong About The American Pharmacists Association.

....and I'm a big enough man to admit it. Lo these many years I've been hurling mean adjectives at them; useless, incompetent, clueless, out of touch with the profession being some of the most frequent. Little did I know they've been working on a master plan for the pharmacist in the trenches. A cure-all elixir of happiness and harmony that will liberate at last those poor souls chained to the retail world of high volume, no breaks, no room for error and no time to pee.

It was unveiled on page 49 of this month's issue of Pharmacy Today  in case you missed it.

First we tackle the problem of stress. You have it, I had it when I was a chain slave, and it ain't getting any better unless you're able to buy your own place and finally do pharmacy right. Fear not though, as the story's appetizer is a stunningly simple solution to the problem:

In more than a decade working as both community staff pharmacist and manager, Jennifer Davis, PharmD, has found at least one solution for countering the stress that inevitably follows a tension-producing incident like a misfill or an encounter with an upset customer: she presses the pause button. 
“Those of you who were involved need to take a break,” Davis, who is now a Fred Meyer Pharmacy manager in Beaverton, OR, will tell her staff. “You need to get off the floor, because the chance of making an error right now is very high.” 

EUREKA!!!!! If only I would have thought of that the time I had to start my Sunday shift as the only person in the pharmacy by dealing with an emotionally fragile rape victim while foaming at the mouth barbarians were demanding their drugs.

My supervisor was disappointed, after 8 hours of playing catch up that day, that the controlled drug inventory wasn't completed. I never forgot their gratitude for my efforts to help that woman. Little did I know it all would have been better if I just would have hung out in the break room for awhile.

But we're just getting warmed up here folks, because The American Pharmacist's Association has been on the case of what ails the retail pharmacy world, and a solution is coming down the pike, baby:

...many pharmacists find it difficult to cope. And rather than promoting the challenges and professional rewards of community practice, many of them advise younger pharmacists to look elsewhere for career opportunities. That was what Mark A. Munger, PharmD, Senior Associate Dean and Professor of Pharmacology at the University of Utah College of Pharmacy, and colleagues discovered in a 2012 survey of more than 300 independent and community chain pharmacists

I just want to pause here and note that it took some egghead until 2012 to realize that pharmacists are likely to tell others to choose another career.

Steps are being taken, though, to reverse these discouraging attitudes, said Munger...


...who is scheduled to lead a discussion, Pharmacist Occupational Satisfaction and Coping with Stress, at the 2015 APhA Annual Meeting and Exposition in San Diego in March


A DISCUSSION!!!!!!!!!!!!!!!!

PROBLEM SOLVED!!!!!!!!!!!!!!!!

(cue Beethoven's "Ode To Joy" right here)

And what might such a discussion entail? The article goes on to give some tasty previews:

Munger said he had heard from both independent and chain pharmacies. Many of the chains, he said, “have developed internal oversight committees that handle their employee–pharmacist complaints or suggestions and then address them by building a culture that relates around appreciation for their individual work, the individual pharmacist’s ideas, and empowers them to make more individualized decisions.”



Ok, stop. Need to focus.


Stop, Drugmonkey. Try to forget what you just saw and move forward.

I just want to say I really want to hear from a chain pharmacist that works in a culture that relates around appreciation of their individual work and empowers them. At all. Any kind of empowerment. I'll put up a reward for anyone who can find me a member of that mythical species.

But wait......the bullshit ain't done being served:

Munger added that many of them are also “building clinical services into their labor projections, which will no doubt improve the workplace environment, as we suggested in the paper, empowering pharmacists to make more clinical decisions. We think that was really one of the major emphases that we got from our survey.” 

Yup, no doubt there, baby. I bet there's noooooooooooooo doubt at all among any of the drugstore schleps beating their brains in to meet their metrics right now.

Alright, one more round of this:

Davis has also learned that diplomacy works best when a patient with urgent needs demands time during a period when patients are lined up at the counter waiting for prescriptions or to be counseled. She will tell the patient: “I would love to spend time with you, but can’t right now. Could I look into this and call you back at a better time?” 
“Ninety-nine percent of the time, they’re totally fine with that,” she added.

Excuse me, Dr. Clueless? THERE'S NEVER A BETTER TIME!!!!!!!!! I cut my teeth at a 24 hour Walgreen's that did around a thousand prescriptions a day, and yeah, we might have been able to work a call like that in around 3 or 4 in the morning some nights. I have a feeling 95% of customers aren't gonna be fine with that, though.

"Um, Drugmlonkey?" some of you might be saying. "I thought you said you were wrong about APhA. It kinda looks like they're kinda clueless and out of touch, just like you've always been saying."

No, my friend, they are more than that. Even more than I imagined. Because the only thing worse than a clueless, incompetent oaf who is unwilling to do anything is a clueless, willing stooge who allows others to use them. It's called the American Pharmacist's Association, but it just gave the corporate pinheads who have taken over our profession a platform to tell lawmakers, regulators, public relations agencies, the media and anyone else in the world who will listen about the progressive changes for good they are making in the workplace. Serious decision makers will listen to them, see the APhA stamp on the statement and move on.

That was a knife you just found in your back my friend. Paid for with your dues.

And until today, I never thought APhA willing or competent enough to put it there.

I was very wrong.

Thursday, February 12, 2015

He Was The Best Of Motivators, He Was The Worst Of Motivators.

Two actual lines from two actual pieces of fan mail received here at Drugmonkey headquarters, honest to god. First up:

I Enjoyed reading your article .... It Is great to hear someone motivating others to take a risk, stay positive

Staying positive, that's what I'm all about baby. On to the next letter:

it's really inspiring to see someone who realizes just how much of a piece of shit everyone in the world is.

Which is kinda like being positive I guess, in a different sort of way.

Such is the dichotomy of the Drugmonkey experience. I am a meat filling of complexity mixed with the guacamole of mystery, wrapped in a riddle tortilla and served up held together with the tinfoil of enigma.

Which is why you keep coming back. Because understandable is boring.

Now I'm hungry all the sudden.

Monday, January 26, 2015

At Last, The End To Our National Narcotic Nightmare

Leafing through this morning's edition of the delivered on dead tree news in a semi-awake caffeine craving state, little did I know the momentous moment that was in store. Not only for me my friend, but for my patients, for you, for the country, and hell, probably even the world. 

That's why I still get the dead tree news. Because if I let myself just pick and choose my news from the electronic information buffet, I would have missed this, and probably have spent the morning reading about how the latest cost projections from the Congressional Budget Office show Obamacare will be coming in at a 20 percent lower cost than previous estimates, then I would be writing a post rubbing that in your face right now.

You wouldn't have liked that, because you would have been torn away from a post about no-go zones in Europe where non-Muslims are not allowed to instead read some left wing slanted news story, when what you wanted was funny pharmacy material. Perhaps a return of the ever popular "Highlights From Today's Pill Counting Action" posts.

A left wing story that happens to be true by the way, unlike that no-go shit that Fox News pulled out of its ass.

So it's a good thing none of that is happening, and that I still force myself to have my news delivered to me like the Johnny Marzetti that was plopped down on my tray every week in elementary school. Or else neither one of us would have come across the breakthrough solution to the most vexing of modern problems.

I'm talking about painkiller addiction. You deal with it, I deal with it, everyone with a healthcare license deals with it, as well as the millions of Americans whose lives have been upended by this plague. Once we had a bright idea to reformulate the OxyContin thinking that would help. What happened was that drove people to heroin and dirty needles and product cut with rat-shit contaminated baking soda the local pusher had lying around his filthy soon to be condemned meth lab trailer out by the old Johnson farm.

Dammit!! What we thought was a great idea turned out to have zero effectiveness! What is the solution to this Rubik's Cube public health dilemma?  Well there it was right in front of me on the printed page.

First though, is a Johnny Marzetti served anywhere other than elementary school lunch trays? And what kind of life do you have to lead to be honored with a vaguely appleish food product?  

God, so many questions this night. But fortunately one big answer.

Because someone, you see, finally asked leading syndicated health columnist "Doctor K" what they could do to minimize the risk of becoming "hooked" on their newly prescribed painkillers.

And if you know one thing my friends, you know that once Doctor K is on the case, he'll get to the bottom of it.

After giving us the lowdown on the basics of opiate/opioids and their uses, the good doctor gets down to brass tacks. Unveiling after what I'm sure took months if not years of research, the key. That's right, now for all the world to see, we have tips from the National Institute on Drug Abuse that will help not only the letter writer, but everyone on god's green earth avoid the horrors of addiction.

But wait, do they really make tacks out of brass? I would think you'd go with a cheaper metal. And why would you say "god's green earth" when any picture from space clearly shows the planet to be blue? I suspect the answer to the latter has something to do with the religious types and their difficulty accepting what science shows to be true.

That's not why you're here though, let's free the people from their narcotic hell, and then we can move on to why the faithful can be so stupid. Here we go, the answer to how we can finally free ourselves from the chains of drug dependence and be free at last, free free free at last:

Keep your doctor informed about all the medications you take. This includes over-the-counter drugs. 
Take your medication only as prescribed. 
Read the information provided by your pharmacist before taking your medications. 
Discuss your medication with your doctor or pharmacist. Don’t hesitate to ask questions if you are unsure about its effects. 
Throw away any unused pills once your back pain improves.    

Jesus Fucking Christ. This is the last time I start a blogpost about something before actually reading the article I'm writing about. I saw the headline before work and was so excited....but now....I'm stuck trying to defend this bullshit as something other than a waste of space.

Really Doctor K? I trusted you, and you treat me like I'm too goddamn stupid to think that maybe I shouldn't take my fucking habit forming meds as prescribed. Thanks there buddy, because up to now I thought a good way to avoid ending up in a twelve step program would be to force Norco down my goddamn throat by the handful. I also figured that hiding the fact I got Vicodin from my dentist would be a great path to moderation as well.

You fuckhead.

It's more than a waste of space, thanks to this antiquated technology it's also a waste of ink and I probably just contributed to the deforestation of the Indian subcontinent. Fuck me.

And fuck you. Go back to your Fox News, because you're not getting anymore Highlights From The Day's Pill Counting Action. Because I don't hate my customers anymore. Because it's amazing how much more likable people become when you finally have the tools to deal with them as an actual pharmacist and not a cog in a goddamn pill mill trying to keep the numbers on your computer screen from turning red.

Jesus Christ I just wasted my whole night on this. Doctor K sucks ass.

Sunday, December 21, 2014

'Tis The Season For Sticking It To Your Employer. Two Guys In The Trenches Simultaneously Inspire And Infuriate Me.

Tonight I feel I should turn in my MENSA card. I no longer deserve it.

We'll get back to that in a bit, but first a report on some chain drugstores who have been more naughty than nice when it comes to their dealings with taxpayer dollars. First we go to the smog-choked depths of Fresno. Home of the worst air quality you've never heard of, probably because to report it would mean admitting to having visited Fresno. While passing out the stacks of albuterol to the people of the San Joaquin valley though, it seems like Walgreen's was up to a bit of no good:

A federal judge in Fresno has reinstated a jury award of more than $1 million in punitive damages against Walgreens for firing a pharmacist who blew the whistle on alleged billing fraud...In August 2011, a jury awarded Fresno pharmacist Sami Mitri $88,000 in general damages and $1,155,000 in punitive damages. 
According to court documents, Mitri began working as a pharmacist for the company in 1996. He later was promoted to pharmacy manager in Walgreens’ Fresno district. The court documents say he first brought the billing fraud to the attention of Walgreens officials in the spring of 2009; Jones said Mitri learned of the illegal practice because he frequently filled in for Walgreens pharmacists throughout the Valley. 
After he was fired in January 2010, Mitri sued for wrongful termination under the whistle-blower statute that protects workers who report employer misconduct.
In a nine-day trial in August 2011, evidence revealed that more than 20 Walgreens stores from Atwater to Tulare and Coalinga to Porterville were found to have fraudulently billed the government involving Medicare and Medi-Cal patients, Jones said. 
For example, if a patient needed 30 pills, Walgreens would give them 10 and give them an IOU for the rest of the pills, Jones said. Walgreens would then bill the government for 30 pills, he said. 
This illegal practice also involved expensive and time-sensitive medication done by injections, he said.

This one baffles me. I did some time back in the day working for the pharmacy America trusts when they're too lazy to get out of their car, and it was very...very...clear how partial fills were to be handled. The company had just been busted for this exact thing not long before and had re-tooled its software to handle these "partial fills,"  billing only for the amount given to the customer at the time, and for the balance owed only when it was actually dispensed.

Furthermore, they were adamant to the point of crazyness that any new hires complete their computer-based training on this partial fill procedure RIGHT NOW!!!, and the documentation that they had done so was put in their permanent personnel records. So for them to get busted for the exact same thing, while firing the guy who brought it to their attention, seems incredible. I suspect the problem was an ignorant District Manager or two. Ignorant District Managers are about as rare as that smog over Fresnoville.

Anyway, whenever I hear a story like this my reaction is always the same. "Goddammit why couldn't that have been me." Cashing in while striking a blow against the corporate bastards that have ruined our profession, what a true win-win that would be. I had a set of standing orders for my keystone tech to periodically rake her memory for things the corporation could have done in the past, as well as keep her eyes out for anything in the present we might be able to cash in on. And until today, I figured we just weren't lucky enough to be in a location where any shenanigans were happening. If you're thinking the same way, prepare to read this one and weep:

Rite Aid Corp. recently agreed to pay $2.99 million to settle federal charges it used gift cards to entice Medicare and Medicaid beneficiaries to transfer their prescriptions to its pharmacies. 
According to the U.S. Department of Justice, from 2008 to 2010, Rite Aid “knowingly and improperly” influenced the decisions of Medicare and Medicaid beneficiaries to transfer their prescriptions by offering them gift cards.

Everyone who works in a chain pharmacy just gasped right now. I heard it. Every single one of you has gone through the gift card bullshit, and many of you noticed the fine print that says these cards were not to be given to Medicaid or Medicare beneficiaries. Those silly few who actually tried to enforce that restriction were universally....universally he said, meaning every time, by everyone, told to give them the cards anyway.

At least, I used to think those few attempted enforcers were silly wasters of time:

The case stemmed from allegations made by pharmacist Jack Chin. The Justice Department said that as a whistleblower, Chin is entitled to $508,300 of the funds recovered from Rite Aid.


Except......only one person was smart enough to do something about it. Sigh.

I'd like to blame my old keystone tech for the fact that 500 large isn't headed our way, I did issue those standing orders after all. buck stops here. So instead of being able to hire a pharmacist to run my store so I can go into the mountains and hang out with the bears, I will be going in to my store tomorrow as usual.

Which still beats the shit out of working for them.

So the best I can do now my friends is to pass on a little advice.  The gift card thing will come around again, and when it does, there will be irate customers who don't understand why they can't have one. When that happens, it might not be a bad idea to ask your District Manager for guidance as to what to do. Ask him in writing. And keep his reply for future reference.

Because evidently getting busted for something, and putting procedures in place to keep from getting busted again, isn't always enough to overcome the power of ignorance when it rests with a District Manager type.

I know a good pharmacy lawyer. When the time comes drop me a line and I'll put you in touch.

Wednesday, December 10, 2014

Do You Know Why I Have Now Inherited The Title Of Best Pharmacy Columnist In The World Now That Jim Plagakis Is Gone? Because Neither One Of Us Ever Wrote A Paragraph Like This.

Look at it:

Clinical community pharmacist (CCP) has begun to appear recently in various venues. It was in the title of a continuing education (CE) session presented at the recent National Community Pharmacists Association convention. The CE session was presented by a panel of innovative community pharmacy practitioners who have been leaders in new direct patient care services.

I just want to point out a few things here:

1) That is the entire opening paragraph, complete and unchanged, of a column in the current issue of Pharmacy Times about, well...who the hell knows? Some character called Clinical Community Pharmacist evidently. Maybe some sort of superhero that can appear in multiple venues at once? If I want to learn about him I guess I'll have to take one of those CE lessons, because there sure isn't much who,what, when, where, or why in this sorry example of news reporting.

2) This was written by a college graduate. He claims to have a masters degree.

3) This illiterate still has a regular gig writing for a national pharmacy trade magazine and Jim Plagakis does not. Chew on that awhile.

4) This also presumably got past an editor at some point. If I ever sent her a turd like this my editor would probably fly out to California and make me eat a dictionary.

I have to go put some water in my eyeballs now, because that piece of work made them hurt and I'm afraid they are about to catch fire.

Thursday, December 04, 2014

JP At Large Cut Loose. My Reflections On The First Great Pharmacy Writer.

There was a time when I hated Drug Topics, the pharmacy trade magazine pretty much everyone in the profession is familiar with. I mean seriously hated it. Every time it was delivered to my store it invariably ended up being leaved through, cussed at, and hurled towards the garbage. What burned my ass about the mag most during of the era of George Bush The Lesser was the incredible platform they had earned over the years, a magazine delivered to and read by almost every pharmacy employee in the country,  and how they were in the process of just blowing it. The magazine got smaller every year. It was printed less frequently. The writing....was bad. Really bad. Here's an actual example pulled from my little blog garden's archives. Keep in mind this was the lead paragraph of a news story:

Can metered-dose inhalers containing flunisolide, triamcinolone, metaproterenol, pirbuterol, albuterol and ipratropium in combination, cromolyn, and nedocromil be phased out because they harbor ozone-depleting substances? If there are alternate products that provide the same benefits as these drugs, they are nonessential and can be removed from the market by, say, Dec. 31, 2009, after a transition period. So proposed the FDA in the June 11 Federal Register. The agency said it would hold a public meeting to discuss this matter. For now, please send your comments to the FDA by Aug. 10.

Reading that hurts my eyes to this very day.

It wasn't only witnessing the self-destruction of what was once the main communication channel for pharmacy that stuck in my craw. It was knowing that I could improve it. If I could only get a shot at writing for those guys, I knew.... KNEW... I could be a part of its renaissance. But I also knew the chances of breaking into the world of actual paid print writing were long and hard. I had even sent Drug Topics a Viewpoint piece once and had heard nothing in reply. So I continued to seethe. Another dip into the archives:

Apparently Pharmacy Has A Code Of Ethics. Who Knew? 
Not me. But there it was in black and white in the latest issue of the trade magazine Drug Topics. The code of ethics by the way, was by far the most interesting thing in that rag, Jim Plagakis being the exception that proves the rule. Why Jim continues to do the clowns that think we'd be interested to read about drugstores in the suburbs on Atlanta putting in generators and publishes statements like "Tylenol was one of the top acetaminophen products suggested" the favor of writing for them baffles me.

Name another acetaminophen product.

Quick. C'mon. No Googling.

See my point? Drug Topics hurts my eyes, and if it weren't for Jim Plagakis and the curiosity aroused by seeing an alleged code of ethics that governs my profession, I might have had to try to gouge them out this Christmas Eve to stop the pain.

Jim had been writing a column for the magazine since I was a zit-faced frat boy who didn't know which end of a spatula to count with. He was the last echo of what they used to be. Kind of like Christiane Amanpour at CNN. And unbeknownst to me he had noticed this angry little monkey man and his blog. Drug Topics was looking for someone to write an op-ed for them, and Jim brought me to their attention. When they balked at the, how do we put it, periodic immaturity of what I was posting to the web, Jim assured them that I could write like a grownup when the situation called for it.

So one day I got an email from Jim Plagakis asking if I was interested in writing an article for the magazine. For those of you not in the profession I'll tell you this was the equivalent of Paul McCartney taking an interest in your garage band and asking if you'd be interested in signing to his record label. And so it began:

The idea came to me while I was waiting for my weekly Andy Rooney fix. I had long ago decided that I can't just tune into the last segment of 60 Minutes to catch the ruminations of the cranky old grandfather I never had. That would be cheating, like reading Drug Topics solely for "JP at Large."

That was the first paragraph of the first article I ever wrote for Drug Topics. I was so proud of myself for getting in that JP reference.

The rest my friends, is pharmacy wordsmithing history. I have proven both myself and Jim right. I got my shot, and I HAVE had a part in moving that magazine towards where it should be. Drug Topics is a  better read today than back when it was breaking the news that Tylenol is a popular brand of acetaminophen. And you know what? My awesome columns are part of the reason why.

This isn't a happy post though, because there is a sad ending to this for Jim. He has been let go from Drug Topics, and in a way that has left him hurt and feeling insulted. That breaks my heart, as he doesn't deserve to be made to feel that way. He carried that publication through the time it was...there is no other word, awful. And to not be given the chance to say goodbye to his many fans reminds me of how they cut off Frank Sinatra's speech when he was accepting a lifetime achievement Grammy.

Paul McCartney, Christiane Amanpour, Frank Sinatra. Have I made the way I feel about Jim clear?

It won't be the same next month when I'm struggling to find something to say before deadline the way I always do, and I can't imagine it ever will be. There'll be a tinge of sadness with every article zapped to the magazine from now on. A little emptiness you can't fill with words.

I wish it had ended better than this.

Sometimes, My Friends, The Jokes Just Write Themselves. That Won't Stop Me From Taking A Crack At It Though.

During the tour of CVS corporate headquarters, it was indeed obvious Foulkes takes her butts seriously.

"No one, and I mean no one, has assembled a bigger collection of assholes than we have right here in this building"  She gushed. "And not just in the drugstore industry. I'll go on the record right now in saying that I don't think there's a company in the history of commerce that has had more butt openings than you see in front of you right now"

UPDATE 1- So here's a real quote from the butt-stopping issue. (God why am I actually reading this magazine?)

After 22 years at CVS, and a multitude of different experiences throughout the organization, Foulkes has “gotten comfortable living in ambiguity,” she told DSN. “I’ve been thrust into situations where I just don’t know, and I have gotten comfortable not knowing."

I think what we just learned here is that the CVS President in charge of stores freely admits to, as many of her employees might put it, having her head up her ass.

Wow, I need to be breaking stories like this, These executives never seem to want to talk to me for some reason though.