The big corporate lies

The Pharmacy Warrior recently posted on his blog  If You’re a Pharmacist You’re On Your Own he elaborated on a “reality show  “You’re Phucked if You’re a Pharmacist“

To elaborate on this reality show… when the BOP hearing was held… the corporate participants relied on the typical big corporate lies to CYA themselves and their corporate master. What are those lies?

Some variation of the following:

1. I don’t remember that conversation – or parts of that conversation

2. That is not what I heard

3. That is not what I said

4. There must have been some misunderstanding

5. I don’t remember that voice mail or email.

In this typical hearing… it is not a court of law.. so perjury is not pursued…  everyone is presumed to be telling the truth…

If you haven’t noticed.. every time that there is something important being said… there is usually a piece of paper involved that requires your signature… like a job review…

If you are being told to do something and the conversation is one-to-one either in person or via phone… you have just been involved in the ultimate interaction that provides the ultimate in deniability… read the above corporate lies…

Likewise.. if you receive faxed communication from corporate/management that has no one’s name on the paper or any ID as to where it came from. If no one is willing to put their name on such… should you be willing to be follow it.. if something goes wrong… no one is standing behind you !

How can you level the playing field?

Anytime you have a one-on-one conversation.. you should follow up with a email – read receipt requested -  to the person who you had the conversation with…

stating your understanding of the conversation on such date/time

such email should be closed with something like …. unless I heard from you otherwise, I will presume that my understanding of our conversation is correct….. print out a copy and take it home… email it to yourself at home.. or save it on a flash drive… DO NOT trust that it will stay on the corporate server.

Even if they refuse to acknowledge the receipt of the email.. there is a paper trail of where/when it was sent… if they don’t respond.. they have – by default – confirmed your understanding of the conversation… if they do respond.. you will get – in writing – what they intended to say or what they really meant to say.

Always express your CONCERNS about comes down from upstairs and don’t wait until you are already in the cross hairs of management… it is then too little too late.

If you are a staff RPh and the edicts are being relayed by the PIC.. your emails should be directed to the PIC… “… I am concerned that this latest procedure is in conflict with the practice act and will create a situation where med errors will increase”… The PIC is responsible for the legal operation of the Rx dept to the BOP.

If you are PIC and get such emails.. they should be forward to HR & management.. if violation of the practice act is at risk… HR is responsible for the Policy & Procedures of the company being followed.. if something is being required that -in your professional opinion – will cause increased med errors.. it is against the P&P of the company.

If these mandates are coming down from non-pharmacist managers… you are just expressing your concerns that they are not aware of the laws that we are required to observe… and want to make sure that they are stating that corporate policy is in conflict and/or violation of the practice act.

It is obligatory that you be  proactive… rather than reactive

How our healthcare system could be more efficient -part one

First of all we have too many for profit entities that are middlemen. It is estimated that the PBM’s net profit of SIX BILLION a yr.. For doing not much more than a VISA or MasterCard function. In fact, that is more net profit than the WORLDWIDE operation of those two charge cards’ net profit.
The insurance industry is one administrative financial black hole.. Skimming off 20%- 30% of every premium dollar for administrative costs and profits.
Then there is war on drugs.. We don’t know how many “health care” dollars or being used by diverters or abusers. Besides all the related dollars spent on law enforcement chasing after legal drugs being diverted or abused.
How can we repurpose all of these dollars to healthcare?
The war on drugs is pretty simple… We quit acting like it is 1970 and use the technology that is available to us.
We are deluding ourselves about the diverter’s access and ability to generate all the fake documents needed. People using fake ID’s and fake rxs is rampant.
This is probably the easiest to solve.. We have PMP but with all the fake ID’s ..they are becoming worthless in catching the serious diverter.
We already have a driver’s license database and a social security database. If the PMP’s had valid information in them they would be extremely useful. What we need is a central database of people with insurance drug coverage.
The process could be very simple from the healthcare provider perspective.
Enter/scan either driver’s license into the website..
The system would bring back the information on the REAL driver’s license… Name- DOB- pic- then the system would cross reference the social security number and cross reference if the person has drug coverage.
The PMP would also be crossed referenced and the PMP would do routine “data crunching” to isolate “persons of interest”
With less than one minute.. It could be determined if the person in front of you who they say they are. If they have drug coverage – when they say they are paying cash – and get a report from the PMP to determine if this pt is an abuse potential.
Prescribers wouldn’t prescribe and Rph could more easily spot a forged Rx ..diversion to the street would dramatically slow down.
I know that this will never happen.. To many entities/people have vested interest in perpetuating the war drug… Power and job security….and they will hide behind “privacy issue”… Like name-DOB-driver’s license & SSN are big privacy issues to those of us who typically have most of  their medical history..

The DEA the loose cannon in the war on drugs

Here is the outcome from that crap in Sanford FL with Cardinal wholesaler and the volume of certain C-II’s that was sold to two CVS stores. Note that no one at CVS ever saw a prescription, saw a patient nor provided any of these medications directly to a patient. That was all done by the RPh’s at CVS… sending in a CSOS order or filling out a DEA form 222 and sending it to Cardinal…and Cardinal gets a TWO YEAR suspension from distributing controls from this distribution center… Where is the punishment for CVS and the RPHs who actually dispensed all of these C-II’s? Where is the FL BOP in all of this… hiding in their offices ?

Just last week… Omnicare settled with the DEA on charges of dispensing controls without properpaperwork….http://blog.cleveland.com/metro/2012/05/omnicare_inc_pays_50_million_f.html

They got a 50 million dollar fine… where is the suspension of dispensing controls for a TWO YEAR period?

Is the DEA playing favorites?

IMO… the bureaucrats have decided that the cartels and the people who carry guns and shoot whoever gets in their way of diverting drugs.. are too dangerous to deal with… and have decided to go after “shoot fish in a barrel”… they are going after entities that have paper trails… doctors.. pharmacies… wholesalers… and don’t necessarily carry guns not shoot at bureaucrats…

Makes good press.. in regards to the war on drugs… but it is harming … all the people who have a legit need for these medications…

Our government is suppose to protect us… is letting the drug cartels to have virtually free roam… protecting us?

Here is article from AP and a quote from CVS…

“CVS Caremark, based in Woonsocket, R.I., said it has cut back “dramatically” on the amount of oxycodone prescribed by the two pharmacies cited by the DEA.”

And what is CVS going to say… BUSINESS AS USUAL ?

The NC BOP has spoken… what a bunch of weenies !

In the case of K*** H*** against CVS in North Carolina .. here is a long version of  where this started http://www.jimplagakis.com/?p=5317

All those involved – except the non-pharmacy store manager and DM… got a WARNING LETTER… basically a SLAP ON THE WRIST to K** H**.. CVS ( Permit holder) and the Pharmacy district supervisor… of course.. since the non-pharmacist store manger and district manager are not licensed by the BOP.. they are outside of the authority of the BOP…

This should demonstrate to ALL PHARMACISTS… that the non-pharmacist management staff … HAVE NO AUTHORITY IN THE RX DEPT !  They need to ask for PERMISSION to come into the pharmacy from the RPH on duty… NO EXCEPTIONS… It is questionable if they can operate the cash register in the Rx dept… and unless they are HIPAA cleared… they shouldn’t even be doing that.

I have not seen the details of the letter.. but .. it took the BOP nearly ONE YEAR to get to this… Is CVS still requiring RPH’s to work 14 hr days?… Is the 150 Rxs/Hr still allowed to be routinely broken?

Personally, what is really surprising.. is that there is not a single corporate RPH on the BOP…. Apparently they seem comfortable with RPH’s working 14 hrs… with no breaks… and supervising multiple techs and filling/processing > 40 Rxs/hr.

Can anyone show me the math where a RPH can supervisor multiple techs and doing > 40 Rxs per hour and properly counseling pts ?

I wonder if these same RPHs are not adhearing to the 150 Rxs/hr/RPh in their own stores… so they can’t go after CVS… for what they may well being done as well….

MALE MBA’s with low ethics get higher pay

Here is a study that suggests that MBA graduates that profess to have little/no ethics get higher paying positions….

is it anyone’s guess that CVS & Rite Aid & Walgreens… hires MBA’s not based on their grades… but …maybe gives them a “ethics test” and the ones who score the lowest gets the job???

Maybe next is to give the same test to Rphs that apply for jobs and only hire the ones with the lowest ethics… less conflict .. between and Rx dept and upper management.

GREED IS GOOD!

If you wondered by ESI & Medco can show 2.5 BILLION in net profits ?

According to this article in FORBES … the brand name industry is basically giving away the farm in rebates.. This might help to explain why before there were “drug cards” and PBM’s… wholesale prices didn’t move much… Almost everyday I work.. I see insurance “formularies” mandating the using of one drug over another for a particular patient… We at the pharmacy level have to spend so much time/energy making sure that the insurance company maximizes its profits. Have you also noticed that MAC’s are not applied to brand name drugs..  guess that the price goes up 10% to and half or more of the price increase goes to the insurance company.. I guess that it also explains why the average Rx price from the 60′s – before PBM’s – was 5.00 and using the CPI.. today they would have been in the $25 – $35 range… instead of twice that… I guess it is not hard to figure out where that other 50% is going !

So you think that physicians do not have patient demand issues?

Here is a blog post that would suggest that Physicians have just as much problem with some patient as we do.. they apparently accept the fact that you cannot please all the people all the time and do what is best for the patient… not tell the patient what they want to hear… or cave in to the patient’s demands.  Yes, we could lose some patients… but .. how much smoother would the Rx dept operate if we could rid ourselves of those 5% -10% of the patients that are “high maintenance”?

Here is another article from MODERN MEDICINE on a similar vein

Find a need and fill it – the basis of building a business

Innovation sometimes creates a need by creating a product that no one ever knew they needed. Take Steve Jobs.. Who ever believed that any of us needed a iPod, iPad, or iPhone.

Some of us have trouble determining the difference between needs and wants. Perhaps this is the underlying cause of many who are over their heads in debt.

Excessive wants can lead to some form of addiction. Tobacco products contain what is suppose to be the most addictive substance – nicotine .. Yet it is freely available… And tobacco use kills 450k annually. Alcohol use/abuse only kills 145k annually and unlike tobacco .. Driving drunk can kill innocent people as well.. Yet, it too, is freely available.

As a society we seem obsessed with a relative small number of people that die from abusing opiates and other substances.

There is obviously a sizable demand for opiates.. People kill each other over it and controlling the distribution on ” the street” over it. They forge prescriptions to get it..

This is not just a problem in this country… So it would appear that it is a physical/mental flaw in a certain per-cent of us homospaiens.

Stats would suggest that for ever one person that is abusing a opiate, there are 19 that have a legit medical need. Yet focusing on the ones that abuse we are preventing those with legit medical needs from getting adequate therapy..

As a society, we are against ” aggressive interrogation techniques ” on those people who would kill innocent people …but we have no problem with letting chronic pain patients suffer in pain because we cling to our Puritanical beliefs … That abusing opiates is wrong.

There are groups – Mexican cartel – that are going to fullfil the “needs/wants” of this market. We have been fighting this war since the Harrison narcotic act of 1914… What has changed ?

We let “bad guys” determine what is to be sold, the price, where it is to be sold, the quality and quantity available…

And all the money is UNTAXED… And the cost of the health consequences ..is borne by our society.. Not to mention the billions and billions of dollars that is being spent fighting this war we have not been able to even begin to win in 100 years.

New Pharmacy school in Eastern Kentucky seems to have pulled the plug

According to this article in Lexington – Herald Leader.. A proposed new pharmacy school that was proposed in Jan 2010.. has now pulled the plug on seeking accreditation from the ACPE… As the surplus of Pharmacists grows… is this the first of many “dominoes” to fall?

Is this how they are controlling costs under Mass’ universal health insurance?

Starting July 1st Blue Cross Plan of Mass plans on limiting the amount of short term opiates that can prescribed and making all long term opiates requiring a PA.. that is unless you are terminally ill. They are concerned that 30,000 of their 2.8 MILLION insured got short acting opiates for more than 30 days.. to save you the math that is ~ ONE PERCENT of their insured and 3,000 received long acting opiates – ONE -ONE HUNDREDTH PERCENT.

What a epidemic.. these guidelines were established ….But Dr. John Fallon, Blue Cross’s chief physician executive, said the insurer spent 18 months working with specialists in pain care and addiction, and others, to develop a plan that balances patients’ needs with a mission to help stem the oversupply of drugs in the marketplace.

It would appear that these guidelines EXCLUDES anyone with chronic pain …that is not terminally ill… AND it took them 18 months…  not to sound like I am bragging.. but I could have done it in < 8 hrs… and it would have BALANCED ALL patients’ needs..

IMO… what a bunch of OPIOPHIBIC MORONS !!… have they not heard about PAYING CASH FOR RXS?.. or is that the point… their stats/metrics will show that they are doing something while forcing those in chronic pain to be able to use the health benefits that they are paying for?