medicaid

here are the brilliant formulary changes my state's medicaid program has made:
-the only PPIs they will cover are Aciphex (the last of the Rx ones that's only brand name) and OTC Prilosec
-they will ONLY pay for BRAND NAME Duragesic patches and MS Contin.
and people want to give our government more control over our healthcare? maybe if they weren't being lobbied by drug companies to make all these backdoor deals.

what? percocet's a narcotic?

winner of doctor of the week:

today a lady who we have had a PLETHORA of problems with filling controlled substances at other pharmacies, trying to fill things early, etc., etc. came in today with a percocet prescription. here were the problems:
1. doctor's signature was illegible. he did provide his dea, but fat load of good that did me since we didn't have him in the computer. he didn't bother to print his name any where on the script.
2. the strength was for 5 mg percocet, but the 5 looked like it had originally been something else. what it was, i couldn't tell, i just knew the 5 looked funky.
3. the amount was originally #60 then it was written over to say #80. the doctor did not initial by the change, so i assumed (as an pharmacy would) that the patient had altered it.
4. there were 3 refills written on the script.

just like any other pharmacy would think, we believed the script to have been altered by the patient. the next 20 minutes i spent getting transfered from department to department in the hospital. first to the er, then to her usual doctor who told me that "never, ever, EVER would he write a script for percocet for her." he has obviously had problems with her in the past. when i finally got a hold of the doctor who had written the script, this was how our conversation went:
me: hi! this is the pharmacy calling. we have a question on a script you wrote.
dr: is it for the percocet?
me: uh, yeah.
dr: yeah, i wrote it. i was initially going to write it for 10 mg, then changed my mind halfway through and decided it was too high. so i changed it to 5 mg. but then i had to give her more pills since i lowered the strength, so i changed it from 60 to 80.
me: oh, ok. but this script also has 3 refills on it.
dr: yeah.
me: um, percocet is a narcotic, a C-II, we can't refill it.
dr: oh, well, then just ignore them.

gee, like i wasn't going to do that anyway. thank you SO MUCH for guiding me in the right direction. idiot. the scary thing is, this doctor has had his license for 2 years. i have a hard time believing this is the first time he's written for a narcotic. i wonder how many other pharmacies have had to explain the law to him. he must have slept through that entire part of medical school.

p.s. bad tech left about 4 days after he was hired. i just realized i never wrote about that.

why anda is the best wholesaler in the world

a.k.a. "i am shallow and you can buy my loyalty." (to be followed by an entry titled "i love our benicar rep.")

1. next day delivery, including saturdays.
2. unlike cardinal, they always manage to correctly print their stickers.
3. also unlike cardinal, they actually remember to GIVE you your stickers.
4. their crazy packing makes me laugh (one box and 3 of those air-puff packs for one bottle of budeprion?)
5. our anda rep ROCKS. she called me back last night approximately 30 seconds after i finished leaving a message. she knew my voice when i answered the phone and didn't even bother with formalities, just jumped right in and started answering my question. she's extremely friendly and is so helpful.
6. that handy anda scanning machine. no entering item numbers to order stuff!
7. free stuffed pandas in our orders!
8. the fact that they carry oxycontin cr generic again.
9. they told me yasmin was going generic about a month before it actually was available. i checked andanet every freaking day for a MONTH. i practically cried with joy when i saw it was available to order.
10. the super nice rep at the ce conference. she was handing out free pandas!
AND BEST OF ALL....
11. they gave me a free ipod! technically i won it at the ce conference, but i secretly think the rep rigged it in my favor because i chatted her up.

proof that you CAN buy my love: i'm going to check every generic we get on monday and see if we can get it even a penny cheaper through anda (most likely), at which point i will then order 10 of EVERYTHING! not really. but i do <3 anda. i wish they would carry brand name stuff too. then i would never ever have to deal with stupid cardinal ever ever again.

the new tech

so for a couple of months now, all the employees at the pharmacy have been begging the owner to higher a new tech. with both of our interns gone, myself going to school full-time, and only 2 full-time techs, we've been a little short lately.
now, however, perhaps being short on techs was the better option.
the owner hired the new tech 2 weeks ago. he started last monday. here are some of the amazing things we have had to deal with since:
-he likes to take off for 45 minutes to get lunch with his girlfriend, and not tell anybody when he leaves. i know by law we have to let him leave for a break if he asks, but all the other techs stay as a courtesy to one another. sure, it might be slow when you leave, but 5 minutes later, we could be slammed. such a thing happened last thursday, leaving 2 techs and a pharmacist to figure things out, without a clerk, as she left early as well.
-he conveniently forgot to subtract the half hour to 45 minutes from the hours he worked, and wrote down a full 9 hours on our timesheet.
-he charged someone $34 for a usually $10 prescription, and $99 for on that is $47. as an independent pharmacy, we have to watch prices very carefully. we also recently found out that the pharmacy he came from (another independent that was bought out by walgreens) had been getting reimbursed by medicaid only $150 for a $280 prescription. no wonder the pharmacy shut down. they were losing over $100 a MONTH on only one prescription.
-lastly, and most scary, he filled someone's robinul with ropinirole. unfortunately, the mistake got past our pharmacist and out of the pharmacy. luckily, it was a really good customer who is extremely nice. she called to let us know she received the wrong medication and we fixed it for her today.
i really am starting to not like the new tech, and i've only worked with him once, since he's only there to fill in the days that i'm at school. the few times our paths have crossed though, i have found him to be extremely arrogant and unwilling to listen to constructive criticism or instructions. if i ever get the chance to work with him again, i will be taking him down a few notches. just because you know how to work foundations, does NOT mean you are the best tech in the whole wide world.

sometimes doctors are retarded

and sometimes they are amazing. i've dealt with a little of both today.

i went to a new general practitioner today as i've had some doubts about mine ever since she diagnosed me with prediabetes after only running one set of tests. bascially our conversation went like this:
me: my periods really suck. i don't know why.
md: well, i think your sister has pcos, so you probably have it too. and so you're probably prediabetic. let's draw your blood.
i was never told to go in fasting to that appointment, so what she thought was a fasting glucose level actually was not. now i can understand that seeing a "fasting" of 115-120 would be alarming. however, she also ran an a1c test, which i think she chose to ignore after having the following conv. with her nurse at a prediabetes clinic:
me: umm, my a1c is 5.1%. is that just okay?
nurse: whoa, no, actually that's great. keep doing what you're doing!
those test results were from october. i talked to the nurse in april. for 7 months i was on four 500 mg XR metformin once a day. when i finally got those original test results i brought them into the pharmacy and discussed with one of the pharmacists whether or not i should continue taking the metformin. we decided that i should try to go off of it and keep testing my blood sugars to see what would happen. guess what? there was little to no change.
so today when i went to see the new doctor, i brought in my old test results with my little notebook of all my blood sugars written down. as i was telling him all of this, he kind of gave me a weird look when i told him i had an a1c of 5.1% and almost freaked out when i told him about my metformin dosage. i am glad to say that i have been officially taken off of it and will continue with lifestyle changes for the next 6 months when i will be retested and we will see where i stand. yay for competent doctors!

pharmacy schools

so this summer one of my goals is to narrow down where i want to go for pharmacy school (and figure out where will accept me...that's another story though). i know that some pharmacy people read this, so i want your opinions. tell me where you went to school and why you loved/hated/are apathetic about it. i'm looking at the northern u.s., specifically northwest. because i hate hot climates. well, not so much that i hate them, just that i'm in a perma-bad mood when the temp climbs too much above 72F. and the NW is still fairly close to the family. but basically i'll go wherever will take me. so yeah. give me some feedback!

sequins, sparkles, and all that jazz

first order of business: highly recommended song of the day - the call by regina spektor. even if you're not a narnia fan, this song is still pretty awesome.

second order of business: people who proved their retardedness beyond a reasonable doubt today.
-extremely overweight woman decked out in sequins and beads with a hairdo that more resembled a fountain than hair. why is it that every woman who looks like this has an obnoxiously, high-pitched, girlish voice? and why do they think that it's cute and try to use their *ahem* girlish charms to flirt with male pharmacy staff? seriously. gag me with a spoon.
-another extremely overweight woman who blamed her swelling on the salts in her Klor-Con. i seriously doubt that the potassium chloride has anything to do with your rings no longer fitting your fingers. i believe a more appropriate culprit would be all the junk food you stuff in your fat, i mean, swollen face.
-man who tried to convince us that the doctor really did mean to write for ms contin 60 mg 6 times daily instead of qid. he sat in our waiting area for near 45 minutes, continually telling us "can't i just buy some until the insurance will pay? i mean, you have the prescription, you know he obviously wants me to be on it." um, except federal law prohibits us doing that. i think we would be the most popular pharmacy in town if we took every person's word on what their dosage was supposed to be. "well, your doctor only wrote for oxycontin 20 mg bid, but if you're telling me it's supposed to be 80 mg every 3 hours, well, okay. i'll go ahead and change it." honestly. the doctor's office finally called us back and told us to stick to the original directions. the man left and said he would come back when his insurance would pay. 5 minutes later doctor's office calls us again to okay 6 times a day. well, you win some, you lose some. i'd rather be on the right side of the law in this case.
-other man whose insurance was requiring a pa to pay for both his oxycontin 40 mg and 80 mg. i called and talk to an insurance agent who was actually competent and told me he could do one or the other, but not both. i tried to explain this to man, but he kept yelling at me telling me i needed to call the insurance. couldn't quite seem to understand that i had just done so.
-man (and his wife) who is on state medicaid. receives monthly oxycontin prescription for $3. but has no problem telling me to not run his percocet rx through insurance and will gladly pay the $90 for it. i wouldn't even pay $90 for a prescription, and i no where near qualify for medicaid. sometimes i hate my state.
-lady with 2 children, probably ages 8 to 10, with a rather ample chest and a shirt that would have been qualified as soft-core porn if it had been any lower. i don't want to see that. you might as well have been the breast-feeding lady.
-another "breast" related issue, another, younger mother with again 2 children, a boy and a girl, around the same age as above, at the kohl's. they go past the lingerie department when mom realizes she needs to get a bra. she tells her kids to look for the "ones with the wire in them." to which her kids immediately start asking what the wire's for. i booked it as far away as possible because i couldn't take any more stupidity today.
-stupid, squeaky shopping cart. not a person, but still annoyed the heck out of me.
-people who call up the pharmacy and say "fill everything we got last time." there will always be something they don't need. "what? why did you fill this?! i don't need this! take it back!" freaking a. how hard is it to call in a list of numbers? oh wait, your fingers are too "swollen" to actually use a pen to write down the rx's you need or to even pick up the bottle so you can read the number off to us over the phone. agh.
-so it's bad enough when you have people freak out at you, let alone when they're people you actually know outside of the pharmacy and know quite well. granted, this woman didn't get in to an all-out freak-out, but she was almost there. i would have lost it if she had started yelling at me, as she was practically like a second mother to me while i was growing up. apparently once you put on the white coat, you're no longer a human being. my favorite though is when people from our old neighborhood come in and no longer recognize me and act like total beasts. they always pull this line of "well, i know the owner and he ALWAYS does this for me." to which i want to reply, "yeah, well, i grew up in the same neighborhood and i know the owner too, actually have known him since i was pretty much BORN, but he's not here and i'm NOT going to do it for you."
-people, especially women, who call in with a question, but when they hear a girl on the line, they always instruct us to ask one of the 2 men who work there. my sweet, female pharmacist got that earlier this week.
patient: oh, well, will you just ask bob (not real pharmacist's name) what he thinks?
pharmD: actually, i AM the pharmacist, and here's what's going on....(proceeds to answer question competently)
i love how customers doubt our knowledge (well, mainly her knowledge as i don't even know 1/32nd of what she does) just because we're young and female. i get this a lot too in chemistry and math classes. my favorite is when it's other women doubting you. seriously, whatever happened to feminism? do you refuse to vote as well because that's your husband's domain? i just love it when i get these weird stares from boys (and occasionally girls) when i answer a question correctly in class that had all of them scratching their heads. yes, you can be smart, strong, AND feminine. WOW! it's revolutionary!

so that's about it. a day of rest and then back to the grindstone. whooo.