Debunking the myth of what brings home the dollars









30 thoughts on “Debunking the myth of what brings home the dollars”

  1. Hate to tell ya, but in TN Cpht are legal to accept new prescriptions as well as copies. Only time a Pharmacist has to take it is if it’s from a state who must transfer pharmacist to pharmacist and even then they don’t usually ask.

  2. HERE HERE!!!
    You said it. I keep getting management instructions to “call on transferred Rx’s” and “Call parents of kids that just got antibiotics to check on their status” and a whole bunch of other crap that does not pay the bills.!!!
    In short, TAP, we are a service industry that has been giving away our services for 100+ years. The general public doesn’t “respect” us, but we’re reminded of how much we are “trusted” every year by some association/academic doo-dah.
    Quite frankly a whole new system needs to come about. I’m sick of transferring Rx’s to competitors (and doing follow up calls) just to transfer it back because they had a $20 coupon. It’s a waste of everyone’s time.
    I would love to see a system where we charged for our services.
    Let’s roll things back and calculate a prescription price as it currently stands.
    AWP-30% + $3.00
    Not a pretty picture, especially if I spend 10 minutes of time verifying data entry of my techs, then verifying product that my tech filled, then (you’ll love this) ringing up the customer, and then answering their silly questions (ex: my medicine says take three times a day, i’m awake 18 hours, so do I take it every 6 hours or is it based on a 24 hours day? No idiot!!! We all in the medical world calculate time as on the planet Venus who’s rotation is only 18 hours long!!! We just didn’t want to tell you about it.)
    OK he’s what I’d like
    Cost of drug + dispensing fee + service fee = total price.
    Insurance, cash whatever, the total is the same, just if on insurance, the copay is from patient, then rest from insurance.
    In more detail…
    cost of drug: not AWP based, but Average cost to PHARMACY!!! (not wholesalers, dumbass government idiot ideas for CMMS)
    Dispensing fee: to cover costs and overhead, (techs, lights, computers, vials, etc etc)
    Service fee: *que the choir* This would be money for the skills and knowledge and training we all spent years of our lives in school to gain.
    Doctors charge and office visit fee, what does a patient get? A Diagnosis and a piece of paper.
    YES! Idiots about to flame me!!! I know what all a doctor does, I’m just making a point from the patient’s perspective.
    When they come to the pharmacy, they pay money and get a bottle of pills. (Again, I know what we do for a living…)
    Point is, we provide alot of service and get SQUAT for it. If we got PAID (not our paychecks but $$ from patient) for services rendered, then I think we’d all be alot happier.
    OK, pick yourselves up, I know, my throat hurts form laughing also… Take a breath…
    How likely is this any time soon. ROFL. About as likely as Jessica Alba knocking on my door. But what steps can we take to move it there??
    As an industry, we have to find ways to get the public and insurance/pbm payors used to the idea of paying us for services. Yes, MTM is one *BABY*step towards it, as is Immunizations. I myself would not mind becoming a diabetic educator, Hell that “service” already has billing codes accepted in the HCFA 1500 forms.. (Yes, i’m old school, props to those out there that know what i’m talking about).
    WOW this was great, Maybe I’ll creat a blog too, hahaha
    I’m not happy with how my practice is TODAY, but I’m hoping there’s a better future for me. It’s changed alot in 20 years since I started as a Tech, and I know that the next 30 years (assuming I can keep some facade of sanity in place for so long) will bring changes that make today’s practice unrecognizable.

  3. Getting new pharmacists up to speed is such a pain. They focus on the things that don’t matter-like what colour the urgent rx’s should be tagged at and whether I check my personal email during my 30 seconds of down-time. Apparently I should take my 30 seconds of downtime and roam the front helping customers. Argh! The worst is when the noob has a daddy that owns the store. Then the noob comes in with all these ideas, daddy lets them because tehy are the darling sprog and the sprog drives the rest of us crazy!

  4. I just graduated in May and am working for one of the major retail chains. I enjoy it in as much as, in reality, it’s pretty easy & mindless. Having said that, I’ve come to realize that rule #1, absolutely by far is to CYA. In other words, I’m only worried about pt safety, customer satisfaction, drug efficacy, etc, in so much as it crosses with covering my a**. In other words, I’ve learned that the greatest thing you can do is to not get fired/fined. Which is kind of crappy, really, compared to most jobs. If I owned my own pharmacy, I would absolutely be more patient-oriented. But until then, I’m just gonna fill scripts and try not to break any ‘company policies’ hehe.

  5. I think this is a little too pessimistic, even for someone who is called The Angry Pharmacist. Sure, the problems of retail pharmacy today are too great to not be considered, but I think it goes without saying that pharmacists today should stress the importance and relevance of MTM, and how it is implemented effectively in the future, without having to sacrifice addressing today’s issues. Reimbursement is of course a major issue, but the key is to show the “people in charge” that Pharm.D.’s are not part of the ills of rising healthcare costs, but more so the prescription (pun intended).

  6. I was about to launch into a comment about this, but I think I’ll wander off and post my own.
    That said, my CphT vs your PharmD/BS/BA…no thank you. Me: lowly pre-pharm with a CphT and under a decade of experience. You: Intensive post-grad study plus any undergrad plus job experience. I’ll stick to my insurances, inventory, and diverting ranty old people to look at candy for you if you do all the “keep people alive” stuff.

  7. My friend got a job interview a while back and he was asked something along the line of what would you do if you have to sacrifice patient care to make the “fill rx in 15min.” He said he’ll deal w/ patient care first. He didn’t get the job…
    So what’s my pharmacy’s solution to this dilemma? Interns do consults and transfers, etc. Pharmacists do the clinical checks.

  8. The whole direction of pharmacy is fascinating, and as much as our officials tell us that we are professionals, you can’t ignore the pharmacy bench reality. Here’s my reality: as a prescription CUSTOMER, I have not been counseled on a new prescription more than TWICE in the FIFTEEN YEARS since the laws were passed. And, almost every time I visit a retail pharmacy, I see the fellow in the white jacket doing one thing, and one thing only: staring at the computer screen with a telephone in his ear. I assume he is doing only the following: online insurance adjudication policing.
    What is fascinating is that the LAWS, RULES, and PHILOSOPHY of pharmacy are heavily onto the professional side now, but the truth is just what TAP said in his post. When is the Yellowstone caldera going to explode? When does the great collision happen? Oh, I hope it happens when I’m around. I have got to see this thing go down. I just don’t know how it will manifest itself. Will the AACP or the ACPE attack the boards? Attack the companies? Cancel all of our licenses? How many more laws and rules will pharmacy adopt? I can hardly wait to see what the regulatory and academic seismograph is going to read. Or, will absolutely nothing happen? Will the lawmakers and officials just keep passing more laws, and more prescriptions will get filled just as they are now? Try answering that one.

    Well, In my state techs can take phone refills but not new Rxs. Frankly I really don’t care what the law says they can do, they don’t do it in my pharmacy. They would have to be an absolutely outstanding tech for me to let them take phone orders. If I did not hear it from the nurse’s mouth, and personally read it back to them to verify it I do not trust it. The last thing I need it is a med error because some tech wrote down what they wanted to hear not what they actually heard (just like the pull bottles and fill Rxs with what they think is the right thing but fail to read the NDC). How do I explain that to someone….really I don’t need the hassle I will just take it myself!

  10. You’re a funny guy, Angry Pharmacist. $50000 for pharmacy school? Just tuition alone it’s gonna be $80000 and I attend an in-state school.
    But it’s true that professors keep talking about MTM, clinical, MTM, etc. However, they do emphasize that some some job positions have more opportunities to practice MTM than others. In my business class, the teacher kept emphasizing how pharmacies have to process a certain number of scripts to make a profit. If they give a discount, then the number of scripts would have to increase to maintain the stay-even point.

  11. I just graduated in May too, like one of the other people who commented. Our pharmacy manager while I was in school taught me way more than the professors ever could have. He taught me how to treat pharmacy like a business, and I wish that every student could have the chance to work with a pharmacist like him. I love making patients feel warm and fuzzy as much as the next health professional- but I know it’s not making the company one red cent.

  12. TAP. Why would you expect pharm schools to teach their students the reality of pharmacy? You of all people should know that those holier/mightier than thou “faculty members” have no clue. This is why I take interns under my wing and show them what pharmacy is about.
    I work for a chain. It doesn’t treat us very well. Overworked and underappreciated. Why should I care to cultivate relationships to grow script count? Why should I care if a prescription is adjudicated less than cost?
    To any newbie RPh pharmacist out there, dreams are made to be shattered. Pharamacist is just a job not a mission nor a cause. Remember, you work to live not live to work (unless you so choose, then all the power to ya!).

  13. Your post is both poignant and misguided, in my opinion. You have done an excellent job of summing up everything that is wrong with the retail pharmacy model, but this time I think you’re missing the mark on the solution.
    The PBMs are definitely the root of the problem with the current “pharmacy as a business” structure. But fixing PBM reimbursement only fixes half of the problem–it keeps pharmacies in business. And thinking of pharmacies as businesses, places that sell drugs, is the same mistake that a lot of consumers/patients make.
    If we want to be a respected as medical professionals instead of shopkeepers we have to run far, far away from the old business of pharmacy and embrace a future where pharmacy is no longer about profit and loss, but about patients. We’re never going to be able to do that the way things are, but we can’t go back to the days of mom-and-pop pharmacy, either.
    I know what I think we should do, but you might disagree.

  14. MTM is what you’re left with after one of the pharmacy associations wraps up one of their weekend long mutual masterbation sessions, errr I mean conventions. What the associations have failed to address when it comes to MTM is how do you convince the insurance companies to pay for it (and by pay for it, I mean pay enough that the profit from said MTM will at least equal the profit that would have been made from the 10 Rx’s that the pharmacist could have filled instead). But they won’t. Why, you ask? Because pharmacists have been giving away MTM for free since the very first Rx was filled at a corner drugstore. Why would they pay for something that pharmacies are handing out for free? They won’t. And if they do agree to pay for MTM, you can bet your sweet ass that the agreement will be followed by a new take it or leave it contract for AWP – 75% and no dispensing fee.

  15. Ole Apothecary, I like your style! Amen! TAP, beings you wont respond on giving me a job? Your right! Get rid of all you high-paid, “thats what I have a tech for” cronies. Go back to 1955-95? Anybody out there have a CLUE what Rph. income was back then? Gee, I wonder if the reason they became Rph. was for the ALMIGHTY DOLLAR? Patient care, the supposed counseling has so gone by the wayside. As a 19yr tech I wished I could of counseled, least the patient would or could know what the hell to expect if something should happen. Hell, pay me 50-60k at 24 hours a week with bennys included. I will run circles around all you poor over worked Rph. Just ask all the interns that have done their rotations with me. My boss sure as hell didn’t teach them financial aspects of running a pharmacy or patient care. I DID! As I have said before, don’t forget whos paying you! ITS YOUR CUSTOMER THAT WALKS THRU YOUR DOOR!

  16. Grrrr. Growling comments today. Maybe this rant speaking directly to pharmacy’s worst fears will evoke gut responses that will put off the Mugwumps. (Mugwumps meaning those ‘on the fence’) It seems that the general tone is of fierce opposition by insurance-payors to regulate the practice of pharmacy. Maybe, TAP is finally coming around to the face-value of an argument validating the use of a one-payor national health insurance.
    In my hospital jobs (where I started out with residency) in the last 3 decades, we certainly did not champion Rx script numbers over professional duties, although it seemed with more specialization in the practice some of us were ‘forced’ into unfair positions of strictly ‘order entry’. Mailout duty in the VA rotation was not a terminal job position!

  17. I think I’d go with the prescription filled in 15 minutes over a lot of “patient care.” I can read the label if I have questions!
    I’ve met some really nice pharmacists lately. I’ve been filling some prescriptions for a bone marrow transplant patient, which is a bit off the usual list of things they dispense.
    I appreciate it when they look to see if they have the drug in stock before I sit down to wait.
    I don’t mind coming back tomorrow if they need to order it, but I really dislike waiting 30 minutes to find out they don’t have it.

  18. Hey “IAPHARMR”!
    Your a what? Your a farmer? So was the asshole Rph who fired me! Late bloomer becoming a Rph which put me with more experience that intimidated him and the threat of a grievence cost me my 19 fucking year career! You asshole, maybe if you werent such a high-falooting asshole and showed some respect you’d find a GREAT tech. Are you superior with your 6 years of college, smock and tie? Go ahead and do it all Mr. Authority. Nice to know, maybe, just maybe you deserve the six figures your making. Oh and hope you know your “CUSTOMERS names” and following OBRA laws, fixing ALL insurance shit, answering the phone when it rings, greeting everyone as soon as you here that door open, waiting on those waiting, adjudicating, posting charge and roa’s daily, outdates, orders, invoices, calling Drs. office when something needs to be changed or fixed, daily reports, perpectual logs, by the way hot-shot, how many prescriptions you filling a day? Last and not least, take out the garbage and scrub the toilet and dont forget the floors. “I” the small fry CPHT, want that floor to SHINE.

  19. I graduate next year from a pharmacy school somewhere in the southeast. They preach, clinical, cinical, clinical, but the reality is that most of us will be in so much debt that retail is the only reasonable option. I figure that’s where I will end up at least at first and I have no illusion of the retail mindset. They might tell you it’s about pt. care up front, but it’s all BS. The bottom line is how many scripts you fill in what period of time. The board sets theoretical limits, but everybody ignores them until there’s a mistake and the subsequent lawsuit.
    Then there’s hospital pharmacy, and tech-check-tech around the corner. Maybe I can repay my $100,000 by opening a nice profitable burger shack. Then the only inspection I have to worry about is the health inspector, maybe I’ll get Larry the Cable Guy.

  20. “Let’s teach the students the TRUTH about retail pharmacy and teach them skills so they can work/operate/design a well-run efficient pharmacy”
    OH, ditto ditto ditto. You know my school never taught that. They’re in their little marshmallow cloud of puffiness.
    (And I *JUST* graduated, you’d think I’d be less jaded!)

  21. I :heart: narcissistic, condescending, douche bottle pharmacists and how they toss around their superior education.
    Pharmacists, listen to me. Not every CPhT is a nine-month-course-in-community-college pharmacy graduate with a framed GED hanging for display in their trailer park home.
    Techs, in hospital pharmacy it only gets worse. Every pharmacist in hospital swings a 10″ cock. And, the female pharmacists usually have bigger cocks than their male counterparts, while we technicians are merely “hired help,” and there solely to massage the taint of lord superior Pharm.D. Some Farmacists will go to such extremes to exercise their authority that the display is almost pathetic and painful to witness. It’s extremely discouraging for techs to deal with such disdainful twats.
    Pharmacists, If you want a fucking circus monkey to swing from ropes and leap through rings of fire to answer a phone that is fifty feet away from the tech while you have a phone not twelve inches from where your precious little hands are typing away on a keyboard – THEN BUY A FUCKING CIRCUS MONKEY!
    Give me a fucking break! Without techs your lives would be far more miserable. You should have left your attitude and your ego at commencement on graduation day. Since you are far too important to have done this, then at least stick it in your fat wallet before beginning your shift and making everyone elses time at work hell.
    You think doctors have a God complex? Christ! Take your heads out of your asses and have a look around.

  22. Wow, QueenLisa, bitter much?
    IAPHARMR seemed to be focusing just on technicians taking phone orders and filling the Rx’s rather haphazardly. I’m an intern in the pharmacy I work at, and I can say that I fully agree with both points made by IAPHARMR. A couple of the techs who work with us have developed the nasty habit of not paying attention when they grab stock bottles. This results in the wrong drug being dispensed, and when it gets around to the RPh, s/he has to waste their time fixing that mistake that a few simple seconds from the technician could have prevented.
    Recently, the pharmacists have started sliding it back down the counter with no more than a “FIX IT” when it happens, and I can’t say I blame them, all things considered.
    The second, and more important, issue: technicians receiving phone orders. The fact of the matter here is that it is not the TECHNICIAN’S license, but it is the PHARMACIST’S license, the license that took 6+ years in school and many hours of experientials to receive. The technicians and interns are all working under the direct supervision of the pharmacist. If the RPh does not want techs receiving new phone orders, that’s his / her decision. Nevermind the fact ( at least here in PA ) that it’s the LAW. I’m an intern, and I don’t even get to take phone orders.
    This is not a cut at technicians. Our pharmacy would not survive more than a day without techs, especially the techs who are worth their weight in gold.
    Be a little more respectful. I could take a few guesses at why your last boss fired you.

  23. Okay, just to point something out: I, myself, am a CphT. And I would never, ever, take prescriptions over the phone. I don’t touch CII’s. My job as a CphT is to handle insurance claims, manage the inventory, manage the other techs throughout the shift to better facilitate the Rph connect with customers and fill those prescriptions.
    Rph’s don’t fill rx’s? Technicians don’t get paid. We are technicians, we are not educated in a pharmacy degree, on the mechanisms of action, and all those other goodies that only 6 years of hell can provide. Do I know how to read Facts and Comparisons and any other medical text regarding a medication? Yes, I can interpert the information to a fifth grade level…but could I counsel a patient on it? Absolutely not. I am damn good at my job, but that doesn’t mean me and my little CphT can do half of what I’ve seen my pharmacists do. We screw up, our boss pays the price.

  24. Oh, some of us have already figured out the whole MTM mess our first semester. I listened to my professors talk about MTM, and I had this grand vision in my mind of setting up a little MTM room where you took the patient’s blood pressure or checked their cholesterol and reviewed their medications. We were told the insurance companies would pay us back.
    Then… the bubble popped. What if the insurance company did not want to pay for it? What pharmacy owner in their right mind would put thousands of dollars into remodeling? At the store I work at, you can’t confiscate any more floor space. My final question: How you could get the MTM to pay the pharmacist’s salary and still rake in a profit for the store? I had to do a report and make up my own hypothetical MTM program. It looked so pretty on paper.
    Don’t worry. Not all professors have bought the pipe dream. I actually had one professor about a week ago mention the term MTM and leave a little snicker. Gotta feel sorry for the professors then. They’re teaching us this crap, and they know it.
    I’ll be honest… I have my heart set on hospital pharmacy when I graduate. I can’t take this retail stuff much longer.

  25. I’ve been a pharmacist for 4 years now. Prior to pharmacy school, I was a pharmacy clerk, technician and intern 12 years before I graduated and got licensed. I value my technicians…if you have a good one, treasure them, treat them well and you’ll get a good employee in return.
    I see both sides of the coin. I’ve been in both places. Yes, I’m the pharmacist, I make the final decisions, i carry the responsibility not them. But, techs are not pharmacy slaves. That’s why I don’t treat mine that way. Most of them are underpaid as it is.
    p.s. Pharmacy school blows nothing but smoke up your ass. I can diagnose a patient’s illness, read their lab values, tell them what drugs to take…but compared to my parnter (my B.S. partner..I have the “golden egg” pharmd haha) I know JACK CRAP about drugs and have learned so much from him in the short year I have worked with him then I ever did in school. I feel like I don’t know anything about drugs like I should.

  26. I qualified a couple of years ago now and it makes me so frustrated when people belittle techs, I would not have survived the past 2 years without mine. I have all the education to do my job, and I reckon I do it pretty well, but they have the education to do their job and in my experience they do it brilliantly. It also however winds me up when techs belittle/don’t respect the pharmacists. Yes techs have great skills, and many are better at their job then the pharmacists, but they dont have the full knowledge that we learn during training, so they need us to. We dont get paid more because we work harder, are better people, are better at our jobs etc. We get paid more because of the more complicated things we sometimes have to do, we get paid more for that overall responsibility that can have us struck-off for a small mistake with bad consequences. We are all working in the same hell-hole together and should show more comradery.

  27. Its simple economics really. Your employer needs you to produce more income per hour than you are paid per hour in order to cover expenses and turn a profit. That being said, it is simply more profitable to fill Rx’s than to counsel or provide MTM. Maybe someday MTM will be more profitable and we will switch our focus. However, if you look at physician reimbursement, you will see that they too are compensated more for procedural work than cognitive services. Performing surgery is more valuable than working with a patient to avoid surgery.
    I guess all grads need to understand that Walgreens, CVS, and all other major chains don’t just magically produce 100k to give you each year. They expect you to help generate the income that allows them to pay your salaries. Read the chapter about work life balance in Jack Welch’s Winning, I can’t say it any better than he does.

  28. I am a third year pharmacy student and I have been working as a technician for a chain pharmacy since I was sixteen. I completely agree with all your gripes about MTM and how the entire business off community pharmacy is designed to fail the patient and generate income. I believe the entire business model is doomed to failure in the next twenty years unless something does change. It absolutely infuriates me that by actually doing your job “all that warm and fuzzy shit” which could make a difference in someones life you are actually hurting the business. This is a just a cold hard fact. You could do your job properly and save a patient a couple hundred bucks but all you really did was lose money as a business.
    MTM as you were saying is also a bunch of crap. It is great in theory of course but ruined in actuality. MTM when it was established was completely off base, first of all any one can perform MTM, even one of those nurses that doesnt speak english and cannot pronounce hydrochlorothiazide. Secondly there is no funding for it anyway. The money for MTM comes from the same pool of money that was given to the PBM’s who administer the plan. So of course they have some retarded idiot in India doing all of their MTM’s for 0.25 cents apiece over the phone. Once again good in theory but shitty in actuality.
    My question to you TAP is what might happen in the future if pharmacist are ever given Provider status under Medicare Part B and are then able to directly generate money by doing all of the correct “warm and fuzzy shit”? Personally I’ve already decided to go into another realm of practice because I am fairly certain that community pharmacy is doomed unless it makes wholesale changes in its business model.

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