Friday, May 25, 2012

Something Of Interest To Every Walgreen's Pharmacist Wading Through CVS Voice Mail Hell Right Now Trying To Get To A Person

Because you may think it's over, after you've pressed 3 for pharmacy, then 1 for pharmacy, then listened to that weird noise that sounds like someone drowning and a few minutes of sleepy-time classical music before finally getting through to a human. Nope. You know a pharmacist is never the first human you get. So you go back on hold and wait some more. But when you hear that second voice you probably think for sure it's almost over. Nope. You now are only at the beginning of a procedure, according to this CVS email the tooth fairy happened to leave under my pillow this morning:



Just Walgreen's though. Evidently they couldn't care less if they're losing a prescription to anyone else.

If I worked for Walgreen's I'd be really pissed right about now.

Thursday, May 24, 2012

Jenny McCarthy Announces Wedding Plans.

ATLANTA, GA- In a joint appearance broadcast this afternoon on the E! network, former Playboy model and actress Jenny McCarthy announced her engagement to SMPX0001:CDCGA, one of two remaining smallpox viruses left on the planet, confirming what celebrity watchers, paparazzi, and almost every doctor and medical researcher on earth had long suspected, that Ms. McCarthy is wedded to the idea of deadly communicable diseases.

"I've been love with Jennifer ever since I first saw her rail against the medical-industrial complex responsible for the scourge that is vaccination" said the virus, believed to be responsible for as many as 300,000,000 deaths in the 20th century. "It's all true. For the love of God, please believe her and keep your children away from these shots of death"

Ms. McCarthy, famous for taking her clothes off and then posing for pictures as well as various parts on television shows, somehow became an expert on vaccine safety. No one's quite sure how. She is the mother of a son with autism that she asserts was caused by childhood immunizations, but an exhaustive search of scientific research papers and medical journals revealed not a single article written by her on the subject.

Not even in The Lancet. And The Lancet sucks.

Commenting on the upcoming exchange of vows, E! entertainment editor Elania Coswell speculated the move would be a boon to the career of the once madly ubiquitous virus. "Like a lot of once popular over the hill performers, SMPX0001:CDCGA is now desperate for any exposure he can get. Kind of like Chevy Chase. How fortunate for him that he found someone whose interests and life goals so closely match his own."

It is widely speculated that McCarthy's influence over vast numbers of people's parenting decisions has something to do with her appearance on WWF's WrestleMania XI and the size of the American education budget.

Looking on fawningly as the smallpox virus addressed the crowd of reporters, Ms. McCarthy later said the couple had plans for a new project.

"Every year since I first spoke up on this issue an average of 178 people have died from vaccine preventable illnesses in this country" she said. "I hope SMPX0001:CDCGA and I can spend some time addressing this problem."

"Oh yeah" Added the happy soon to be groom."Trust me, if I get my way, those numbers will change. Now how about seeing who you can blow to get me out of this lab baby?"

Ms. McCarthy then psychobabbled something about thimerosal, a preservative removed from almost all vaccines in 1999 with no resulting decrease in autism cases.

Most reporters wrote down every word she said.

Thursday, May 17, 2012

One Thing I've Learned About CVS Employees. They Really Seem To Hate CVS.

I mean really hate CVS. Every company has its disgruntled and malcontents, and I've found those types can be useful ones to seek out when I'm writing about drugstore shenanigans. But man, every time I put out a call for people willing to give me the skinny on these guys, I am inundated with volunteers. No other company even comes close.

And now, I don't even have to go seeking. This email from a CVS employee showed up completely unsolicited. I know every company has executives that like to play business hardball, but it's becoming clear that this company is distinguishing itself in an industry that seems to take pride in treating its employees like shit.

Of course I could be wrong. Having given space to this employee, I'll happily give more to anyone who would like to pen a rebuttal. Anyone who's itching to tell the world all the great things CVS is doing to advance the profession, or even just how they aren't as bad as the other guys.

The offer is open. There's an email link to the right of this page where it says "tell me what you think"

Without further delay, from a CVS employee. Complete and unedited.


I open this post with a quote from Hunter S. Thompson:


"In a closed society where everyone is guilty, the only crime is getting caught. In a world of thieves, the only final sin is stupidity."


Why do I quote Thompson when talking about CVS, or indeed any Corporate Pharmacy? Because we live in a culture that silently condones cheating and fudging to make the numbers look good. If you work in retail, you know what "The Numbers" are. If you don't, I won't waste time explaining it. If you google "Triple S" or "Key Pharmacy Metrics" you'll get it. Let me get to the heart of what's wrong with CVS's culture of numbers:


If a store is not selling enough scripts (notice I didn't say filling), getting high enough ratings on the Triple S/KPM, or their inventory is out of whack in any way - they get endless hassles from district. This forces stores to do whatever necessary to make themselves look good. Refilling scripts without asking patients, filling dubious CII scripts to make their script budgets so they can maintain staff levels, and literally stealing receipts to boost their customer survey scores. This sort of thing is ignored by the higher ups because it boosts the district's numbers, until someone blows the whistle. I've seen Pharmacists fired not because they were cheating at the scores, but because they slipped and forgot to cheat one month and made it far too obvious that they were doing so.


Notice that it wasn't a manager or district supervisor who called attention to the CVS stores in Sanford, FL who were filling ridiculous scripts for Oxycodone and other narcotics from pill mill doctors. They were tickled pink and the gobs of money that were coming out of these stores. If a technician hadn't blown the whistle and called attention to what was going on, it would still be happening and those stores would still be the most profitable ones in the area. Once it was out, CVS immediately sent emails to every store with instructions that no one at any level talks to the press. CVS associates are to forward all requests to some yahoo in the corporate PR office (Head of Media Relations or some such nonsense). Everytime we see that email, we know that something's gone wrong again for CVS somewhere in the country. We've seen that email more in the past 4 months than in the previous 2 or 3 years combined. The CEO and everyone high up in management said the same thing, "It was irresponsible of these people to accept these dubious scripts and to keep filling them. They did so in contravention of CVS policy." Policy that was quickly changed from "Fill the scripts, or you're fired!" to "We stand behind you. Don't fill scripts that you think are improper or outside the standard of care." shortly after this story hit the airwaves.


Pharmacists used to be able to simply wave these people off by saying that it was out of stock, but now that's been abolished too. The policy changed again, "You can only say you're out of stock if you are legitimately out of stock. Otherwise you have to explain to the customer that you cannot verify the script and will not be filling it because in your professional opinion..." et cetera. Why? We were never given a real reason. My theory is that it's a way of ensuring that these people end up at our competition rather than another CVS. Maybe it's some sort of reverse Honeypot trap, trying to get Walgreens or Rite-Aid to fill a pill mill script and get them nailed to the wall instead.


Going back to that earlier point, about people being fired for not filling scripts they thought were bogus? Not an exaggeration. Customers would complain to corporate and demand the Pharmacist give a full explanation why they would not fill the script. These dressing down sessions would end in a filled prescription for the patient and a gift card for their inconvenience.


The culture of numbers is to blame for the CVS stores in Sanford filling those bogus scripts. That culture is also responsible for CVS's outside vendor of scripts Cardinal Health losing the DEA license at their Lakeland warehouse for providing those stores with the narcotics. Now CVS has to appeal and fight to have those stores' DEA licenses restored. At the same time they're fighting to fix these two stores, they're going to close two completely legitimate stores in other locations that do good business for their communities.


It sucks to work for a company with such a warped sense of priorities, but what can you expect from a retail company that sees pharmacy only as a way to make money? A store doesn't make it's RX Script budget by filling scripts, but only by ringing them through the register. 'Did you fill 4500 scripts this week, while lacking two technicians? Well, you only rang 1950, so we're cutting your hours again. You'll have to let someone go. What's that? You won't be able to cope with the extra workload? I'm sure you can go somewhere else then and we'll get someone who can, and boost your store's Triple S at the same time. Bye!'





It's disgusting, and we're stuck with it.



Tuesday, May 15, 2012

Let's Watch Pfizer, Eisai, And The FDA Take A Perfectly Reasonable Situation And Shoot It All To Hell.

First off, a little tip. Any article that starts with the words: 

Four months before a best-selling Alzheimer’s drug was set to lose its patent protection

Will not end well. It just won't. No matter how normally the story starts out.


 “The hypothesis was that patients with more advanced Alzheimer’s disease could benefit from a higher dose of Aricept,”


You see? That sounds reasonable enough. I have a hypothesis that a 500mg dose of Viagra would give me a mother of all boners, allowing me to make sweet love to my girlfriend for a month straight.

Who, by the way, is the most awesome girlfriend ever. Have you noticed the lack of  "Oh my god, does he need an intervention" type posts of late? There's a reason for that. But I digress.

The thing about hypotheses is that they need to be proven before being put to use in the practical world. At least ideally. I mean, I wouldn't just take a handful of blue diamonds and book an oceanside retreat for the month of June, you know?

The F.D.A. had initially said that to be approved, Aricept 23 would have to improve both cognitive and global — or overall — functioning in patients with the disease.

Yay FDA. Making people prove things. Pretty much how this science stuff is supposed to work.


 But the clinical trial found only a slight improvement on the cognitive measure and no improvement on the global measure.


There we go, guess the end of the story will be coming up soon. 


As a result, a clinical and a statistical reviewer for the F.D.A. each recommended against approving the higher dosage. 



Yawn. This story is so boring and routine it's starting to put me to sleep.


Nevertheless, the drug was eventually approved by Dr. Russell Katz, director of the F.D.A.’s neurology products division

Huh?

who acknowledged that side effects from the higher dose “could lead to significant morbidities and even increased mortality,” but concluded that the drug most likely improved overall functioning even though the study did not show that.


Welcome to bizzaroland. We crossed the border so quick there some of you might be a little disoriented. Let me repeat something:

the higher dose could lead to significant morbidities and even increased mortality.


"Increased mortality" means more dead people.

but concluded that the drug most likely improved overall functioning even though the study did not show that. 


"the study did not show that" is probably self-explanatory.

So why on earth would the FDA approve a dosage not shown to work but that was more dangerous? I mean, that's the exact fucking opposite of how things are supposed to work.


Aricept generated more than $2 billion in annual sales since its first approval in 1996


Oh. Just a theory, but I'm gonna go ahead and go with it. Just like the FDA did. Except I have more evidence than they did.

In 2009, Eisai applied for a 23-milligram version of Aricept, a dosage that, the journal authors note, cannot be reached by combining the 5 and 10 milligram dosages, which are available in generic form.

 Yup...there's me some evidence right there. I think I can close this case and move on to the Viagra question now...

...after careful consideration, I've decided I'll be keeping my regular boners. No matter what the FDA might have to say on the matter.

Monday, May 14, 2012

OK, So That Time I Wrote About CVS Getting Fined For Something Once A Month? That Was Supposed To Be A Joke.

Tough thing about being a jokester though, is that real life often robs you of your material:


VENTURA, Calif. (KABC) -- CVS Pharmacy has agreed to pay nearly $14 million to settle claims that it illegally disposed of hazardous waste at many of its California stores. 
A Ventura County judge approved the settlement on Wednesday. Two years ago, allegations surfaced that CVS improperly disposed of medical, pharmaceutical and photographic waste over a seven-year period. 
Fire and environmental health departments in 45 cities and counties in California will share the money from the $13.75 million settlement.

What could they possibly have on tap for May? Stay tuned to find out.

Thanks to the alert reader who tipped me to the story.

Minnesota. The Ultimate Shangri-La. Who Knew.

From Friday's paper. I may have added a few things:


ST. PAUL — The Minnesota Vikings moved to within a governor's signature of getting a new $975 million stadium today after the state Senate approved a plan that relies heavily on public financing.

Gov. Mark Dayton, who presides over a state where evidently every last pothole has been filled, has said he'll sign the measure, because no one can possibly think of anything else to do with hundreds of millions of dollars of public money, meaning the Senate's 36-30 vote was effectively the final barrier for the stadium. The House passed it overnight.

The bill's passage came as a relief to the state's teachers, who according to union spokesman Blake Peters, were concerned their salaries might be raised to the level of engineers, investment bankers, or perhaps even advertising executives.

"No way we're worth as much as those guys." Peters said in an interview after the vote. I'm just glad the talent currently going into those professions won't be tempted to set foot in any classrooms."

The team would pay 49 percent of construction costs: $477 million, which is $50 million more than owners initially committed. But the public expense is still high: $348 million for the state and $150 million for the city of Minneapolis.

That's $498,000,000 to create about 90 high paying jobs.

The issue created a rare moment of bipartisan harmony as the state's liberal activists reported that every poverty stricken child now had adequate nutrition, housing, and after school programs, the state's parks could not possibly be any more well maintained at twice their annual budget, and drug rehabilitation and vocational training programs in every prison had three times as many openings as applicants. Likewise, Bud Matthews of the conservative think tank Minnesotans for Economic Growth issued a statement that read in part, "We're totally not interested in any tax cuts. Our entrepreneurs have everything they need to continue to create jobs and maintain our strong economy. Our priority should and must be pouring our resources into making sure a ball gets pushed across a chalk line."

After the Senate vote, jubilant Vikings vice president Lester Bagley hugged another team official and shouted, "Let's build it!" Vikings fans broke out singing the "Skol Vikings" fight song and the Senate president admonished them to take it outside the chamber.   

That was real. I didn't make up a single word in that last paragraph.

Economists generally applauded the move, seeing it as avoiding a repeat of the 5-year long recession that followed the Minnesota Lakers move to Los Angeles and the pain of  losing the Minnesota North Stars, which might have played hockey, or maybe soccer. We're not really sure.

At press time, a motion to allow taxpayers not interested in buying a ticket to a football game one complimentary look at the new stadium was expected to fail.


Wednesday, May 09, 2012

Another Nominee For The Lloyd Duplantis Of Gray, Louisiana "Worst Pharmacist Ever" Award.

If you don't know who Lloyd is or why he has the honor of having the "Worst Pharmacist Ever" award named after him, you should search the blog or buy my book. I would prefer you buy my book because then I get money. You also get a kick-ass book. Total win-win.

Anyway, our tale today comes from the land of Donny Osmond and Brigham Young. A land formerly of many wives and currently of world class skiing. I'm talking of course of Iowa. No I'm not. I just decided to mess with you there for some reason. We all know it's Utah. To the city of Draper and the town's local K-Mart, which employed a pharmacist named Robert Lammle:

Police said Lammle decided "to mess" around with the customer’s prescription on Oct. 20 after he verified with a doctor that the prescription for 240 oxycodone pills she provided was fraudulent.

Hm, this is actually kinda promising so far. I'm generally in favor of messing around with prescription forgers.


Lammle filled the prescription bottle with M&M candies and sold it to the woman


And if the story ended there our reaction could be... bwwwaaahhhaaahhaaahhaaaaa. I once worked with a guy who actually did this. The story doesn't end there though.

When the woman called later in the day complain about the candy

....which takes some chutzpah.

 police said Lammle told her she had to pay him $500 or else he’d turn her over to authorities and she’d lose custody of her children.

Hahahahaha....just a little messing around. Kinda like when I just told you I was writing about Iowa. Except I didn't try to make you give me $500. It gets better though.

Four days later, the two allegedly met in secret at Kmart and Lammle gave the woman 240 pills for free, charging documents state. Police said he told her she had week to sell them and bring him $3,000.
 Another pharmacist, coming back from lunch, ran into the woman in the store’s parking lot and watched her run up to the drive-thru window and obtain the bag of drugs. That pharmacist checked the pharmacy’s records and noticed that Lammle had generated a prescription for the pills, police said.

A solid argument for making sure every pharmacist gets a lunch and every pharmacy drive through gets shut down I would say.

On Oct. 30, the customer called Lammle and told him she was only able to sell half the pills, and he told her to bring $1,500 and the remaining 120 tablets at night when he was working alone, police said. Investigators said the woman hadn’t actually sold any of the tablets. 
Lammle was charged with the third-degree felonies of solicitation or arranging to distribute a controlled substance, obtaining a prescription under false pretenses and a misdemeanor count of attempted theft by extortion.

By the way, I once heard Donny Osmond tell Howard Stern he'd never once had a blowjob, and I believe him. There's something about Mormons that fascinates me. So creepily clean-cut. That doesn't have anything to do with this though. I guess my mind is wandering.

Lammle, 51, of Salt Lake City, later told Drug Enforcement Administration agents that he thought his "pressure" tactics would force the woman to get help and go to rehab for her purported drug addiction problems.


 Which totally explains the $3500 he was going to get from the deal. He was probably going to donate the cash to pay for her treatment.

Mr. Lammle, your name is now officially in nomination. I have a feeling you may soon learn more about blowjobs that you ever thought a person could know.

Thanks to the alert reader who tipped me to the story.

Thursday, May 03, 2012

So, I'm Pretty Sure This Guy Gets Some Sort Of Triple Crown Of Pharmacy Customer Award. A Quick Lesson For Those Of You Not In The Pharmacy Business.

Picking up some clonazepam, a sedative much like Valium he was. After asking if it was too soon to fill (which means he has been told before that a prescription he wanted couldn't be filled yet)

Then asked if he had ever had his Adderall, a brand of amphetamine, filled here. (Because he can't keep track of the multiple pharmacies he uses for his meds)

He had. Next question, "It wasn't billed on my insurance was it?" This question will seem the most bizarre to those not in the profession. "Why on earth would you not want to use insurance?" you're asking yourself. But when you're using multiple pharmacies to pick up the same med you see, the second one you try will generate a "refill too soon" reject when it files your claim. The way around this is to use your card at one place and pay out of pocket everywhere else.

There are the questions we hear all day long. Rarely though, from the same customer. In the same transaction. Guess the moon was lined up just right.

And to top it off, he had one more query.

"Yeah....um......what happens if you give Viagra to a woman?"

His girlfriend was there next to him. And she looked appropriately horrified.

I went to school five years for this.

Wednesday, May 02, 2012

Counselling Tip Of The Day.

Found this in the official prescribing information for Topamax while looking something up:

Other adverse reactions that occurred in more than 1% of adults treated with 200 to 400 mg of TOPAMAX® in placebo-controlled epilepsy trials but with equal or greater frequency in the placebo group were headache, injury, anxiety, rash, pain, convulsions aggravated, coughing, fever, diarrhea, vomiting, muscle weakness, insomnia, personality disorder, dysmenorrhea, upper respiratory tract infection, and eye pain

So.....100% is greater than 1%. I guess that means every person coming to the counter with a Topamax dose over 200mg a day gets told there could be a 100% chance this shit's gonna happen to them.

Thanks for clearing that up Janssen.

Book Review Number 5. Remember When CIGNA Killed Nataline Sarkisyan?

I do. I wrote about it at the time and hope to never forget it. Nataline was a 17 year old California girl who fell seriously ill and needed a liver transplant. At least that's what her doctors said. A paper pusher at CIGNA said she didn't though, and I'll bet you know who won that argument. Nataline is dead. A massive public outcry that did manage to embarrass CIGNA into changing its mind wasn't enough to save her. She died two hours after the company reversed its decision. A story that is literally uniquely American.

Wendell Potter remembers too. He was head of corporate communications for CIGNA at the time, and as such, it was his job to put the best possible spin on this story. To make the company that denied a teenage girl her last chance at life somehow look not evil. "Our deepest sympathies are with the Sarkisyan family" Potter wrote after Nataline's death. Sympathies so deep evidently, that a few months later CIGNA employees heckled and gave the finger to the dead girl's mother when she came to CIGNA's headquarters to talk about what happened.

I'm not kidding you. Employees of CIGNA gave the "fuck you" gesture to the mother of the girl they helped kill. If this Obamacare thing stands though, we might have heartless bureaucrats making life or death decisions about our healthcare. Can't have that.

Dealing with the Sarkisyan story broke Potter. He doesn't write about the heckling in his 2010 book Deadly Spin, An Insurance Company Insider Speaks Out On How Corporate PR Is Killing Health Care And Deceiving Americans, he does write about being relieved at the time that CIGNA wasn't mentioned by name in most of the headlines in the first wave of news stories and blog posts that followed Nataline's death, and he does tell of how the whole experience managed to finally awaken the long dormant humanity that was present in an insurance executive's soul. How a process that began the day he witnessed Americans desperate for medical treatment line up at a county fairground a day in advance of a charity health clinic...

The scene inside was surreal. I felt as if I'd stepped into a movie set or a war zone. Hundreds of people, many of them soaking wet from the rain that had been falling all morning, were waiting in lines that stretched out of view. As I walked around, I noticed that some of those lines led to barns and cinder block buildings with row after row of animal stalls, where doctors and nurses were treating patients. other people were being treated by dentists under open-sided tents. Many were lying on gurneys on rain soaked pavement. Except for curtains serving as makeshift doors on the animal stalls, there was little privacy...Dentists were pulling teeth and filling cavities, ...doctors and nurses were doing Pap smears and mammograms, surgeons were cutting out skin cancers.

  ...came to fruition when he had to become the point man for the company that denied a chance at life to a fully insured client. Wendell Potter quit his job, testified in front of a Senate Committee on how insurance companies "confuse their customers and dump the sick, all so they can satisfy their Wall Street investors", and he wrote this book  Wendell Potter was broken, and he confessed.

He confessed to the ways you are manipulated by the modern corporate public relations machine. Ever wonder why so many people insist that the government "Keep their hands off my Medicare?" Why so many people continued to believe cigarettes and cancer weren't related even after being buried in an avalanche of evidence? After reading this, you'll have an inkling as to how people can be convinced to say and believe the absurd. You'll learn how the demise of the Clinton health care reform plan led to a significant factor in today's health care mess, the transformation of Blue Cross and Blue Shields from an association of non-profit health insurers into for-profit public stock companies. You'll find out that because of a law intended to protect retiree's pension plans, you have for all intents and purposes no right to sue your health insurer when it denies you care, even if it leaves you looking death square in the face.  Like any confession, it is informative, educational, and a voyeuristic window into how things really work on the dark side.

It's also unsatisfying. It should feel better to have Wendell Potter on our side, able to bear witness to the truths we have been shouting from rooftops for so long, but I found the book depressing, merely reinforcing my belief that to be on the opposite side of money in a fight is to be a permanent underdog, no matter if truth is in your corner. For every Wendell Potter there are hundreds if not thousands just like he used to be, bought and paid for and kept in line with a river of dollars, while Wendell will spend the rest of his life with nothing but the meager power of truth on his side.

If you are the type that is interested in the truth though, then by all means give the book a read. Remember as you do though, Nataline Sarkisyan is still, and will always remain, in her grave.




Deadly Spin on Amazon.      

On Barnes and Noble

Or find it at a library near you.