random haps

One of my favorite things to do when someone calls on the phone to ask "Do I have refills on my hydrocodone?" is to look up their info (so they hear me typing) and then answer quickly "Oh, no." I usually get a squawk of rage- "Yes I do!"- to which my mental reply is "Then why the F&@k did you just ask me? Ask if it's too early, fool."

I kept having people ask me today to repeat things they just told me, or for doctor's offices, to resend requests for PAs. One nurse, when I repeated that we had sent it multiple times, just asked for the info again as if this couldn't possibly be an issue. Rage, I tell you.

One of my customers called to ask me what a doctor had written a script for. She said she was going to spell the drug, and then went "M-A-I-N-S-T-R-E-E-T. What drug is that?"

"Ma'am, I think you spelled Main Street."

"Oh yeah, that's my address."

*headdesk*

She ended up never telling me the drug name- she skimmed the rest, figured out it was her Ambien, that it was too soon to refill and then hung up.

I had a guy get a flu shot, and he asked me to help him with his consent form. Being a soft touch (sometimes) I read him the questions, kinda begrudgingly, until he said, kinda to himself, "I haven't learned to write with the other hand yet, after the stroke."

Of course, then I was perky and helpful.

We have this one office that usually e-scripts nowadays, but sometimes they'll have to call something in. What do I hear when I answer the doctors' line "Hello, this is Hell Pharma, technician speaking?"

"Pharmacist."

No hello, please, thanks or even attempt to be nothing but rude. Seriously, I tell every patient considering switching docs to avoid this office like the plague. I don't see why saying a greeting is taking up precious moments of your day.

January is fast approaching, or as I call it, Pharmacy Apocalypse Month. With the Express Scripts/Walgreens kerfluffle, everyone's going to see shifting people and it's gonna be nutty. I plan to stock up on sweet, sweet rum now.

Glucose Testing

I was looking at videos on YouTube of ideas for noninvasive blood glucose testing. There is a huge project looking at measuring glucose in human tears. I have a lot of issues with this.

The team working on this is making testing devices that are meant to touch the surface of the eye to get tears then analyze the glucose content. The device itself has way too many limitations to be clinically feasible. Any degree of Parkinsonism, tremors, many physical handicaps, contact lens wearers, visual difficulty, and poor hand-eye coordination will limit the ability to touch the testing device to the eye. The actual touching of the eye is quite disturbing in itself. Scratching they eye, poking the eye too hard and sterility of the device are all very real hazards.

The eye is very delicate. Please leave it alone and try to find a noninvasive way to measure blood glucose through the finger like a pulse oximeter measures oxygen saturation. There has to be something in the blood stream that will react with a different spectrum of light that will allow for quantifiable and reproducible results. It took about 40 years for the original pulse oximiter to be redesigned and put into widespread use but I believe somewhere out there in research land there is a team of scientists that can make this happen.

I want a viable noninvasive cost effective means of blood glucose measurement and like Veruca Salt "I want it now!"

I Foresee A Misadventure

As I look into my crystal ball I see a bottle of Pradaxa opening and the capsules placed into a 7-day pill minder. The caregiver filling this pill minder does not know about the storage mandates for this medication leaving the patient open to drug failure and clots.

I am asking each and every practitioner to make sure to double or triple counsel each and every patient you are putting on Pradaxa and any caregiver(s) they are going to have involved in their drug routine.

Pradaxa is extremely sensitive to humidity and should be taken as prescribed every day for 30 days after the seal on the original bottle is broken. Pradaxa SHOULD ONLY BE DISPENSED AND STORED IN ITS ORIGINAL CONTAINER!!!!! Absolutely under no circumstances should this drug be taken out of the bottle or foil pack and put in a pill minder unless you have a foil pack and cut off the cap still in the sealed compartment and put that whole unit in the pill minder.

Pradaxa caps should NOT be opened and the pellets taken by themselves or sprinkled on food because the bioavailability goes from 3 to 7% from the intact capsule and increases another 75% with no capsule. This can lead to a potentially fatal bleed.

Please make sure to go over this info multiple times with each patient and caregiver(s) because this med can easily be misused and when it comes to clot fatality vs bleed out I believe everyone will benefit from some good old education.

Let's Talk About Sex

I'm not going in to the freaky deaky stuff for the time being but I do want to address a growing and sad issue: Plan B. Multiple times each work week I see panicky scared little girls come in for Plan B or send in their boyfriends to buy it because they are TERRIFIED that their parents will find out what dumb ass little teenage loser they let wallow in their baby gutter. This needs to stop.

If you are so afraid or too embarrassed or too immature to have an open adult dialogue with your parents about sex then you have NO business f*cking!!! My parents failed to do this with my older sister who got pregnant in high school and hid it from the family until her last few months. They made sure I knew about baby making and venereal disease and got on birth control at an appropriate age. What is an appropriate age? That has been debated by religious and parent/teacher groups for years. I recommend operating on the "old enough to bleed, old enough to breed" paradigm.

Upon a girl's first menstruation it is imperative that parents have a discussion about dealing with blood, birth control, and venereal disease. Let's face it, being a girl is disgusting and it helps to have a good home support system. Parents should have the talk with boys when they start getting "morning wood" and "nocturnal emissions." It is up to the parents how detailed they want to get and if they want to take the mom tackles daughter, dad tackles son on the talks. They also need to agree on rules for dating for their children and please allow them to take the health course at school that goes over reproduction and social responsibility for their offspring. It seems this education has been lacking on all fronts worldwide.

Knowledge is power and with the potential to make a baby teens should have greater responsibility and knowledge for planning a baby at an appropriate time in life instead of having one and dropping it in a dumpster or using it for a welfare check. I guarantee many of your children are having sex and not telling you about it. Make sure you have a good little sit down chat. If you are uncomfortable with it there is a Planned Parenthood where you can make an appointment for your child to talk to a health care professional for any questions they are uncomfortable asking you. Let's take the fear out of growing up and bring RESPONSIBILITY back to our baby-making!

Oh No She Didn't!

Oh yes I did! Tasty now has a Twitter account for all the little things I want to say but just don't need a whole blog post.

Your new favorite thing is @FFPTastyTweets

MWAHAHAHA

What The Smurf?!

Clash of the Titans

In case you have been hiding in a bomb shelter for the last few months you missed the announcement that Walgreen's was not going to renew its contract with Express Scripts for prescription processing at the end of 2011. They have already dropped E.S. employee rx processing and are ready to give the rest of them the old "heave ho".

Why would a pharmacy business give up a ton of customers, including all military rx insured? Due to craptacularly low reimbursement rates from the processor (ie E.S.). Why lose a sh*tload of money if you don't have to. This is not the first time Walgreen's has gone toe to toe with an rx insurance provider. There have been many instances in the past with different state medicaid programs and other rx processors in which Walgreen's just said "No". Quite frankly I don't blame them one bit.

I say f*ck you Wal-Mart (and Sam's Club) with your $4 rx (and no charge to mail it to your house), and a smaller f*ck you to Target for jumping on the $4 band wagon (No hard feelings Target I still love you, it's just a matter of principle.) Oh yeah, I didn't forget you Costco, f*ck you too with $6 prescriptions and a "you don't have to be a member to use the pharmacy" policy, and a special lick my twat to all the grocery store pharmacies with the list of free antibiotics, and to any other rx chain that has such equally bastardizing low ball tactics to get business.

This pricing bullsh*t is what makes insurance providers believe they are entitled to craptacularly low reimbursement rates because if we can fill over 300 drugs for $4 then we must not really need AWP (average wholesale price) + a finger in your ass for reimbursement, which is the industry standard right now. This means we will get less than AWP and not even the uncomfortable "how you durin" of a finger in the ass for employee hours, supplies, drugs, utilities, patient counseling, vaccinations, etc. You know who gets the really short end of the stick? Independent pharmacies that are subjected to the same craptacular reimbursement rates with a much higher drug acquisition cost. Even being in a buying co-op isn't gonna save most of them.

As a "f*ck you" return serve to Walgreen's, Express Scripts is trying to buy Medco, which is another huge rx benefit provider. E.S. states that they will "save money by being a bigger company" but we all know they just want to bend Walgreen's over to get them to take the craptacularly low reimbursement rates and the rest of the retail pharmacies will have to bend over and take it too. This is a bitter pill to swallow indeed. The only hope is that the Federal Trade Commission prevents the buy because E.S. will then control about 40% of the prescription market and will have way too much control over the industry.

If the FTC does as wonderful a job as the Congressional budget fix then the pseudo-comfortable "we can make a few bucks and keep the lights on" days of retail pharmacy will be at an end. The new dawn will bring obliteration of what was once a landscape of semi-prosperous independent pharmacies to a place where only chain retail pharmacies remain. Just one more American dream shat upon by the greed of others. Go Team!