When chains rule the world…

Although they sure as hell don’t realize it, PBM’s (like ScamImp-..er..MedImpact)  really do need small independents to continue their existence.

Imagine if you will, when all of the PBM’s have driven all of the little guys out of business.  No more mom and pop stores as far as the eye can see.  Sure, this might make the PBM’s happy because their executives got a 4.5 hochillion dollar bonus this year off of the backs of the little guys they put under, but now they have to deal with the two big angry gorillas of the pharmacy world:  CVS and Walgreens.

Now, when MedImpact/Argus/etc sends their contracts to these retail giants with their AWP-25%+0.07 rates, do you think that the two big boys on the block are going to sign that?  Hell no.

You see, now they sorta have to, because independents are still around to take care of the patients if the big “evil” chains refuse to sign that contract.  Its illegal under anti-trust acts for true independents to collectively refuse to sign a contract.  So you’ll find at least one pharmacy in town who’s stupid..er..CARING enough about “Patient Care” to sign that horribly low reimbursement rate.  However when we’re all gone? It’ll just be the big boys, and they have a LOT of stores and don’t like to use much lube when it comes to the bottom line.

MedImpact will waltz up to CVS and offer something horribly stupid (because thats how PBM’s roll).  CVS will look at the contract, send it around to each store for the pharmacist to wipe his/her ass on it, then return it to MedImpact.  If they terminate CVS’s contract, then MedImpact’s patients just lost about 1/3 of the stores they can get their Rx’s filled.  Walgreens will do the same thing, and eventually you’ll have a PBM that has no pharmacy to call home.  See, the PBM’s will have eliminated all of the competition of the chains vs independents.  They don’t realize it yet, but its slowly happening.

So whats a PBM to do?  Easy, stop fucking over pharmacies.  Take a REASONABLE fee for processing the prescription (ie: don’t make more per Rx then the person who is filling the prescription like you are doing now), PRINT THE RIGHT INFORMATION ON THE FUCKING ID CARDS (so we don’t have to call), and stop being fucking slimy crooked piece of shit banes of the pharmacy world.

Which brings me to my second issue:  At what point do we throw down the gauntlet and put ‘patient care’ aside for our own livelihood and well being?  At what point to we refuse to sign the new contract that these pieces of shits send our way and collectively stand as a profession against the abusive-husband that we call PBM’s?  When do we grow the balls to tell Mrs Smith “I’m sorry, but we no longer take your insurance because doing so will cause us to go under.  Go and complain to your insurance company about their processor”.

You know how I rant on here about how annoying and stupid patients can be?  Now imagine them not yelling at me, but having them collectively yell at the PEOPLE THEY PAY to manage their pharmacy benefits.  Of course trying to get pharmacists to do anything collectively is like herding cats; and we probably need a committee, a fancy name that has a cool acronym like DILDO, yearly meetings with pharmacy school students, a publication, lots of pictures of people who have NEVER WORKED A FUCKING HONEST DAY IN THEIR LIVES with fancy letters after their names, award ceremonies for “Something” of the year (which means absolutely nothing), scholarships, more publications, requests for membership dues, etc.

Thats right, I’m ragging on CPhA, APhA, ASCP, and the other alphabet soup organizations who want me to join their organization in exchange for magazines full of pictures of students who don’t have a fucking clue and old-guys trying to re-live their glory college days.  WHY AREN’T ANY OF THESE “organizations” DOING SOMETHING ABOUT THE PBMS!!!  Oh, because they have no idea about PBM’s because THEY DON’T WORK RETAIL.  Before you can “Advance the Profession of Pharmacy(tm)(r)(wtf)” why don’t you try to fix the insurance clusterfuck that we have going on now.  I know that its hard work shaking hands and getting your picture taken at the latest convention at the Marriott, but seriously, DO SOMETHING or we’re going to have to take your “patient care” that you so dearly hold true and preach to everyone about (btw, whens the last time you even SAW a patient? How about actually worked in a pharmacy?) and throw it aside so we can pay make payroll.  Roll up your sleeves, put your fancy labcoat (with your name embroidered on it and has never seen a pink amoxicillin stain) aside, and GO AFTER THE PBMS!

The organizations should be going to the PBM’s and say “The cost of doing business is $x.  At your reimbursement price, pharmacies CANNOT survive.  We are going to recommend to ALL OF OUR MEMBERS to not sign up with your plan.”  Anti-Trust? Sorta, but this is to all the members, most of which who are chain pharmacists and non-owners.  Bah, its a pipe dream.  Maybe they are doing this, but seriously to the guy in the trenches whom it effects, I see zero.

Realistically, I’m betting on the chains to do the dirty work based solely on their monopoly on the industry vs the people that I pay dues to represent how I see the profession.

34 thoughts on “When chains rule the world…”

  1. Wow, there was a lot validity, and that was SOME rant.
    Only thing I want to mention is there are more patients than pharmacists (therefore much more confusion and room for obfuscation), so as both a patient and a pharmacist…most patients will/have not have figured out what is going on, or at least not believe the feds are ‘allowing’ this to happen –at this LEVEL of the ultimate consumer, but I don’t think that it’s my business to ‘grow the balls to tell Mrs Smith “I’m sorry, but we no longer take your insurance because doing so will cause us to go under. Go and complain to your insurance company about their processor.”‘ notwithstanding the consumption of copious amounts of testosterone and other steroid manipulations of a biological process that would have to occur.

  2. Revolution has to start somewhere. Indies even collectively don’t have much power. Until the big chains feel financial pain nothing will change. So start something and stick a sign up that you don’t fill rx’s for xyz plans. Provide a phone number to call if they complain and leave it at that. Stick to it. Spread the word to others like you and pray for a shitstorm to erupt within a few years for the McChains. Don’t count on the sniveling Poindexter motherfuckers at the professional organizations to do anything. Won’t affect them. No interest. Just sit behind your desk with yer big yellow buck teeth and type up another column about how much you know about The State of Pharmacy for some free bullshit pharmacy rag taking up space in 50000 pharmacist mailboxes. Almost makes me wish for the machines to take over prematurely to make it stop. But then I wouldn’t get to see them get their asses McGreased.

  3. I ALWAYS encourage my patients to go to a mom and pop pharmacy over the chains. Of course, they are going to go where they want or, more to the point, where their PBM’s want, but I have always had a lot more trust in the local pharmacies than the big chains. Local pharmacies actually know their patients names and lives, and just seem more competent and caring.
    Let’s hope that we never see the end of the mom and pop pharmacy. If we do….well, that is one more reason to go practice in Australia!

  4. Hey TAP, great site. I read it every week.
    I agree 100% with everything you have said. I must say this, and I hate to say it, but the pharmacy community, we have no balls. We have too many pussy footed sheeple (people + sheep) who just bend over time after time. Half the sheeple don’t care that this happens and then the other half don’t even know it happens. What the pharmacy community needs to do is actually GO AFTER the PBMs and insurance companies, and utilize lawyers. Sue the damn bastards.
    The other thing that needs to happen, is these pharmacies that accept AWP-30%+1.50 need to refuse those contracts and tell them, come up with a contract that actually makes me money, and then we can do business.
    We need a real badass to go after these people.
    Keep up the wonderfully sarcastic angry rants. I love it.
    -3rd Year PharmD/ MBA Candidate

  5. spot on TAP!
    But you fail to mention the big boys and the wannabes and the $4 prescription nonsense. That is another reason the PBM’s see fit to screw us is because we are already doing it to ourselves.
    I am proud to work for a chain that doesn NOT do the four dollar nonsense, nor do we match prices. I’ve got a great crew, good customers, and our business continues to grow. Yes we’ve lost some to Wal-mart but we’ve gained far more in return from them. And it’s people who value their time more than saving two bucks!

  6. Unfortunately though, when this happens, I am sure that many insurance companies will require their customers to get a 3 month mail order prescription. Some companies like medco are already doing this.

  7. The ‘professional’ organizations don’t have time to go after the PBMs, because they’re all too busy with their pathetic MTM circle jerk. …don’t you know, retail jobs won’t exist in a few years, and all these pharm school grads will be partnering with other healthcare providers, performing clinical functions, and ensuring ‘optimal medication outcomes’.

  8. TAP:
    What will happen when/if the US gets socialized medicine. I am not too sure where you are from in this country but from previous posts it seems like CA.
    I believe they had/will pass some sort of socialized medicine law? For example, I believe in England all Rx’s are about

  9. Beautiful as always. Oh the way you string those pearls of prose together, just fantabulous.
    Surely those drug dependent dickheads are too lazy to vote for anything?
    I second the suggestion to move to Australia but I

  10. Yeah, I think I bought into the whole “retail pharmacists won’t exist in a few years” BS for a short while during my first year of pharm school. Then I met some older pharmacists who told me they heard the exact same thing 15 years ago. Its a statement coming from clinical pharmacists who typically work several days a week in retail to supplant their lower incomes (source of jealousy). Unfortunately simple economics will always keep retail salaries higher. Wouldn’t you take an office based 9-5 without all the hassles of retail if it paid more? Chains have not stopped dumping money into pharmacy programs….which serves to indicate that they still beleive they will need retail pharmacists in years to come.
    As for the PBM’s TAP is right, some jerk-off will always be willing to lose money “because it will drive front store sales” (said in most mocking tone possible. Pharmacies need to return to a cash and carry policy. Let the patient dick with their insurance company for the money, we offer a real service, and it is time to grow some stones and admit that to be the case.
    JustaDoc, i have served time at both independent and chain pharmacies and all I will say is that I saw a hell of a lot fewer errors at the Indie, despite the fact that they have not spent craploads of money on patient safety. It relates to staffing issues, chains deny that overworking a pharmacy staff leads to more errors, but its a lie.

  11. Excellent idea man, but it’ll never happen. Something like this does have to start grass-roots style though.
    But tell us how you REALLY feel about APhA?

  12. Amen TAP! I was part of that elitist group and gladhanded with the best of them. The PBMs rule. You should do a rant on retarded HR directors who sign these PBM contracts and have no idea how their company is getting screwed over.

  13. Any takers on funding “This Bad Ass” tho my ass is actually quite nice. haha I’d love to open a can of woop-ass! I’d be the the 19yr experienced tech that got canned by a pussy. I lightened the pussys load handling most of the 3rd party bullshit. I know third party and boy do they suck! When I started in 1989 I believe there where 2 carriers and now a-f—— million! Hey, Mr Angry?? How bout that job? I need to get back into swing. I miss out-smarting insurances and getting my way. Always pissed off the less experienced I worked with. Rph. loved it, of course.

  14. A-fucking-men!!
    Are you a member of TPA yet? I could really use your insight and help. All this is exactly what we are trying to do. There are not enough of the indies to affect any change.

  15. Excellent and well thought out.
    I to hate APhA and the like but not, ASHP, because if there is one pharmacy org that is going to carry the future of pharmacy, ASHP is it. But at least ASHP doesn’t purport to be retail-oriented.
    People in APhA are all too busy giving each other hand jobs over how awesome their research is and how many pens they distributed at last year’s convention.
    Pharmacy has no answer to physician’s AMA. Our organizations are mostly worthless, self-absorbed, and blind to the real problems of pharmacy. They see MTM as the future. Tell me, now… can you run a self-sustained pharmacy on MTM? Yah, that’s right, I didn’t think so. While don’t we try to find real solutions rather than these bull shit “Community Residencies.”
    Community residencies are the pinnacle of our schools having their heads up their ass. Community residency = I don’t want to work hard like I’d have to in a hospital and I don’t want to dispense prescriptions, but I still want to make tons of cash! Fuckers…. It’s times like these that I really think about why I chose to go to pharmacy school and unfortunately, I’m not longer sure what my answer is.

  16. “If you can’t beat them, then join them”
    I am waiting the day that the chains start to merge the with PBMs similar to the CVS/Caremark deal a while ago. Caremark and CVS had a lot of overlap in terms of store concentration and member concentration. This was not a merger to expand into new marketplaces. Rather just make the existing ones more profitable.

  17. Excellent rant sir. I tip my yarmulka to you.
    Who owns PBMs anyway? Medimpact (who thank G@d we don’t have much to do with, here in NJ) seems to be privately owned. Are any of them publicly traded? Maybe we should all pool our resources and buy assloads of stock in them, and then we might have some say in how they’re run…
    I do remember back when I was in school, say 12-14 years ago, that Independent Health (Western NY based PBM notorious for pinching pennies) was in fact suing a bunch of independent pharmacies for anti-trust violations for exactly this problem: they’d banded together and told IHA where they could shove their contracts.
    Now, the chains can get away with that kind of thing. Rite Aid (and possibly the other chains) refused to take Cigna for a while, and of course I laughed my ass off when I read in the trade rags that CVS and Walgreens got together and told the state of Mass. that if they followed through with their planned cuts in reimbursement, there would be huge areas of the state with no pharmacy access for Medicaid patients… See, you and I can’t do that, but they can, and make it stick. (Of course I was “they” at that time, being a CVS employee.)

  18. Doesn’t PBM stand for “Pucker up, Bend over, and Moan”!?!?Doesn’t PBM stand for “Pucker up, Bend over, and Moan”!?!?

  19. This rant really comes down to consumer preference vs a pharmacist preference. Most if not all consumers prefer a PBM. Instead of going on this mad rant against PBM’s and seeking annihilation of the PBM Industry, why don’t you propose solutions on how to change it. In your case of Mrs Smith, let’s imagine a world without PBM’s. Mrs Smith goes to fill her prescription for a drug she desperately needs, and the drug ends up running $1000. What average American can afford something like that?
    Yes, the PBM’s may take a return on the drug more than the pharmacy, but the pharmacy is running thousands of scripts in a day compared to the minority that the PBM is contracted to run through the pharmacy in a day. The PBM’s may not be up to all good, but who in the corporate world is? The same exact thing is going on with the oil industry. The drug industry has the ability to return big profits, and the profits are either going to end up in the hands of the drug makers, PBM’s, or the pharmacists. Yes, the PBM’s are making excess profits compared to the pharmacists, but most consumers will not do without their PBM’s, so it’s looks like they are around to stay for a while.
    And another thing: why is this coming from someone like a pharmacist? Last time I checked, the average salary for a pharmacist in the United States was $90,000. The salary seems like compensation enough for a job like that. I just don’t get it: In American society it’s the have’s that seem to complain more than the have not’s.
    So let’s look at this problem from a more logical viewpoint. Instead of just complaining about the PBM’s, let’s propose solutions. I for one am for socializing medicine more so than it is now. I’m not talking about complete socialization like Canada, but to a degree where we can eliminate corporations that seem to take advantage of the medical system as is evident from their huge profits.

  20. CM, TAP has given a solution. Looks like you didn’t read his post very well. His solution was to get the pharmacy organizations to go after the PBMs. We are not seeking destruction of the PBMs, just fair play. They control too much. PBMs should not take a bigger cut than the pharmacy IMO. They don’t deal with the customers like we do, nor do they take the risk of losing money on drugs that expire, nor do they take the risk of getting sued. BTW, profits do not end up in the hands of the pharmacists. Our pay is defined by the market and the need for pharmacists. To answer another question, this is coming from a pharmacist because pharmacists in general, give a damn. Just because we make upwards of 100k a year, doesn’t mean we should keep our mouths shut.
    As for socialized medicine, it may sound like a good idea, but I honestly don’t trust the government at this point to set it up well. They fucked up medicare in 2003 because they didn’t listen to pharmacists, they fucked up the VA before Ken Kizer fixed it, and most likely they will fuck up social medicine. I like the idea, but it doesn’t seem pragmatic for the time being. No one has come up with a good system as far as I have seen either. (God I could write a book on this topic.) Not to mention, as a future pharmacist, I would be worried about my wage in the future under socialized medicine. No clue how it would be affected.
    -3rd Year PharmD / MBA Candidate

  21. CM
    it all comes down to simple economics really. Now this is more of a concern for pharmacists in independents where profits can be especially tight. Yes, pharmacists make a lot of money, that being said, in order to pay pharmacists lots of money the pharmacy needs to take in lots of money. When a PBM cuts our margin of profit on prescriptions we end up having to fill more prescriptions to make the same amount of money. Factor in the pharmacist salary, rent, utilities, legal cost of doing business, and the fact that the owner of the pharmacy is evil for wanting to make…gasp… a profit, and this is a very sensitive issue.
    PBM’s in my opinion do very little to earn the profits they make, other than squeezing the life out of pharmacies. Now you may think this is whats best for the consumer, but as they put more and more independents out of business, they will be eliminating your ability to choose where you get your prescription filled.
    Also, on the issue of consumer preference….I really doubt most consumers are in favor of PBM’s, seeing as how most people give me their medical insurance card not realizing they have a separate care, or they can’t tell me who provides their prescription benefit because it sure as hell is not the blue cross they claim to have.

  22. I’m sooo lost. I’m a non-practicing, licensed frustrated pharmacist, who is scheduled to take the FPGEE exam this coming December, and my US visa got denied! 🙁 the Consul was asking me for a work-related experience.. Just for taking that exam! Now my dream of rubbing elbows with the great TAP was blown into smithereens.. I’m so sad… 🙁

  23. Sorry TAP to interfere on your blog but I would like to answer Queenlisa1.
    TPA is The Pharmacy Alliance. I am the Chair of the indie side of the organization. You can find out anything you want to know about us at http://www.thepharmacyalliance.com. There is a forum and our 14 principles.
    Anymore questions, you can find me on the forum.

  24. What about more cash business in pharmacies and screw the pbm’s? I know brand drugs are expensive and need insurance to pay for them. But why do we need insurance for generics?
    Then again I am just an indy-want-a-be who has got stuck in a chain because it looks impossible to start my own pharmacy….

  25. I always use the same pharmacy…a chain it so happens, but they treat me very well and know me and my family…however I will admit they have actually accidentally given me too few or too many pills on occasion.
    They know me so well because after two surgeries my GP physician, a young woman, took over prescribing me pain medication. She would prescribe almost whatever I asked for. I did not get high or sell them but I admit when I tried to stop taking them and got very sick so I got scared of going into withdrawal. Consequently I just kept getting them and in increasing doses. 3 weeks after my last surgery the GP was prescribing me 25 mg of Percocet a day…a year later it was up to 350 mg of oxycontin a day. She knew I went to AA meetings…I am 20 years without a drink and it seems that as my surgeries healed I should have been getting less narcotics, not more. Also as an ex-drunk I would think she would have been more conservative with me. However at AA we learn to “own up” to our part…and like I said I asked her for refills as I feared withdrawals. I was truthful with her about my tolerance going up as well. Every month or so if I took what she prescribed I would in a matter of hours start to experience withdrawal symptons (I had them when I detoxed from alcohol in 1986).
    Eventually I started having psychological and emotional issues and so she prescribed Lexapro along with the narcotics. Finally I got suicidal but a little voice told me “its the drugs”. I “fired” that doctor…I had told her what was happening but all she did was give me a referral to a “big-shot” pain management doc in DC who I had to wait months to see. I could not wait…I was planning to step out in front of a tractor trailer so my son would get my insurance.
    I went into a drug program and they got me off the painkillers but I am still taking this suboxone…the doc at the rehab said because of my pain (which can be bad but not terrible)) I should continue on it. However now the surgeons want to redo the knee surgery…but no way after all the problems I had with narcotics.
    I can’t understand why my GP had kept prescribing the meds to me…she is a very good and popular doctor so it is not like she needs to do that to keep patients.
    The whole time this was going on I got to know my pharmacists very well…I was in there so often…I would even bring them coffee and donuts when I went to pick my meds up. They also never questioned all the drugs I was taking. Is that normal? Admittedly I am a pleasant looking person, a traffic engineer who dresses nice and is articulate but don’t pharmacists also have a responsibility in these matters? No one seemed to notice or mind until I almost lost my mind.
    I talked to my sponsor and other folks about this situation and the general opinion was it was my responsibility not the GP’s or the pharmacy’s. I tried to talk to the GP a few months after leaving her practice but she would not talk to me. All in all I spent a lot of money getting off the narcotic painkillers and I am still addicted to this suboxone. I am not a happy camper. I cannot help but urge pharmacists to not just accept the situation because a physician’s signature is on the script. However I also know how God awful busy pharmacists are
    so individual care or concern for a customer can be pretty tough to give.

  26. CM,
    What kind of fucked up logic is this?
    Chains collectively may run thousands of scripts per day, but the Indies certainly aren’t. There are only a handful of large PBM players. Do the math. Let’s say there are 3 major PBM’s nationwide that control 90% of the payments. If 3 major chains control 75% of the # of prescriptions per day, that leaves another 25% spread across Indies/small local chains.
    The sum of that equation is that the PBM’s can tell the chains and Indies to bend over and take it even harder than a crack whore’s ass!
    Ahem, moving on…..
    I’ve always enjoyed working in a hospital environment. I don’t buy into that retail vs ‘clinical’ bullshit. We all (hopefully) work in the environment that’s the best fit for our individual tastes. I am not jealous of retail salaries. They earn every penny. They work their asses off and take abuse from the public. TAP is more than justified in his rants.
    I am more than happy with my salary. After over 17 yrs of practice, and working a variety of positions in my hospital network, I found my niche about 3 yrs ago working in an outpatient oncology clinic. The doctors, nurses, patients, and support staff are nice and respect my opinion. I get unique and challenging questions every day, while juggling multiple tasks at a time, including dispensing high risk medications where one major mistake could easily kill someone. Many of the hospital pharmacists I work with would rather stick a fork in their eye than spend one day doing what I do. That’s all good. You work where you fit in best, and I’ll work where I fit in best. I don’t have a PharmD, and I’ve never done a residency. But I’m damn good at what I do and I bust my ass every day I go to work. Do I go home sometimes wanting to explode from tension and anger over the ridiculous bureaucracy that is hospital administration and Medicare reimbursement? Of course!
    Socialized medicine: Sounds good in theory, but our government seems bent on making paying for healthcare as complicated as possible. It’s all a fucking shell game to keep their costs as low as possible. Look at Medicare Part D. Instead of coming up with a deductible that is fairly common and simple for the public to understand; they come up with this doughnut hole. Which is just about impossible for some 86 yr old little old lady to understand. And once they fall into the doughnut hole, forget about paying for that $$$ Emend prescription to keep you from getting nauseated from your chemo. Instead, you can puke your brains out and have to go back into the clinic where Medicare will pay twice as much for those IV fluids for the next few days because you are so dehydrated.
    It’s that kind of ass backwards government logic that makes me leary of the US government coming up with a decent socialized medical plan that doesn’t screw pharmacists and other healthcare providers out of business.

    Just curious, what about big supermarket chains with pharmacies in their megastores, Wal-Mart, etc.? Are they almost-as-big angry gorillas of the pharmachy world too, or do they stand up for their pharmacists so little that they might as well be mom-and-pop stores which can’t stand up for their pharmacists much, or what?
    How many consumers even know what a PBM is? I didn’t know what PBM stands for until I saw another one of the blog’s posts mentioned on another site, came here, read this post, and then looked up “PBM” to know who was pissing off TAP.
    The public ought to learn that retail workers are people too!
    Besides, today one retail pharmacist gave me awesome help. I had a question about whether an OTC nutritional supplement (one recommended by the doctor who deferred me for blood donation) was contraindicated with a prescription medicine I take. He accepted my question even though I wasn’t dropping off or picking up a prescription, told me the supplement wasn’t a problem with my Rx medicine, asked about my allergies, told me it is contraindicated with one of *those* (whew! close one!) and happened to have another version which isn’t contraindicated on the shelf (which I did buy). Hopefully this stuff will help me get accepted next time I try to give blood. Thanks to this pharmacist, patients who need blood transfusions will have more blood available!

  28. I couldn’t agree with you more. We have to get the word out nationally. I suggest contacting John Stossel (?). He is a real savvy reporter for ABC (20/20…I think). He is very approachable if the cause can show how inefficiencies exist in providing health care (PA’s, stupid insurance card formats, no formatted mag strip on insurance cards like VISA, etc.). I would approach it from a time and money standpoint and how this adversely effects patient care by bogging us down with horseshit admiistrative tasks. Did you know that the total number of transactions via computer for pharmacy claims is second only to VISA Mastercard, etc combined?
    I’ve spent 15 years in pharmaceutical research and 20 years as a general manager for Life Sciences with the largest computer company in the world. Just retired. Decided to go back to retail for shits and giggles, and was vastly surprised how the industry is still stuck in the mud with goofy insurance programs. I have been lucky enough to have finished grad school and have received an M.Sc., Ph.D., and a useless Pharm.D degree. So I’m not stupid. But trying to enter information even on one of the best retail chain systems is frustrating and painful.
    Why do we have to go through this PBM horseshit? The chains we work for don’t seem to give a shit. And the professional associations are very useless in this regard.
    If we don’t get national TV exposure on this subject, our grandchildren who become pharmacists (God forbid) will be echoing the same line 50 years from now. When are we going to wise up? Enough with the BAD publicity about pharmacists (KC R.PH dilutes drugs, Walgreen techs from High School, and Manny Moore).
    Contact me anytime if you need help.

  29. I agree that PBM are screwing us all. But why don’t you try ranting as a member of your state association. As past president of my associaton I tried in vain to attack PBMs by getting together with the chain association and attacking them. But the PBMs are strong and very well funded and money talks (Diane Wilkerson is a prime example) Patients need to be informed about these unfair business practices,chains don’t care any longer, they own the PBMs but the least active members of the associations are chain employees, because they feel that the chains will take care of them. CVS is paranoid about pharmacists organizing, lately a push by Pharmacy First, a union organization has been met with threat mail from the corporate office. We must unite and use over voice, ranting is great but it does nothing to solve the problem

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