I am the Crazy RxMan, your local pharmacist... smart enough to be a pharmacist, insane enough to work retail!
Sunday, April 21, 2013
Saturday, April 20, 2013
Too Busy at the Pharmacy?
"The expectation is that all pharmacists will utilize these storage units going forward," as stated in a recent email from our regional manager.
Friday, April 19, 2013
TOP TEN Profitable DRUGS at My Pharmacy in 2012
1. Quetiapine 200mg (Seroquel generic)
2. Fluvirin 2012-13 (flu shot)
3. Oxycodone 30mg
4. Zolpidem 10mg (Ambien generic)
5. Fluzone HD 2012-13 (high dose flu shot)
6. Endocet 10/325mg (Percocet generic)
7. Oxycontin 40mg
8. Azithromycin 250mg Z-Pack
9. Oxycodone/APAP 5/325mg (Percocet generic)
10. Montelukast 10mg (Singulair generic)
And thus you see WHY retail pharmacy is CRAZY for flu shots! Corporate will pay BIG MONEY to refurbish/expand the retail pharmacy for flu shots but ironically won't fork over more tech hours so we can deliver seamless service to other pharmacy patrons.
Thursday, April 18, 2013
Know When to Fold 'Em
During the course of our conversation, she somehow gets the idea in her head that I have told her she needs an oral antibiotic. I correct her-- no, she needs something for the eye. I tell her there are antibiotic drops for the eye and make a couple of suggestions but that she really needs to be examined by a doctor. She asks me if the "drops" will upset her stomach and once again I realize she thinks I'm suggesting an oral antibiotic. Mind you I NEVER said anything about an ORAL antibiotic. Finally she gets the message and leaves after touching everything on the counter and now it's time to disinfect everything.
The next day I arrive midday and the tech tells me that the insanely tall lady was there in the morning with an Rx for Erythromycin ophthalmic ointment and that she was upset because I told her to talk to her doctor about "drops" for the eye and she wondered if I gave her wrong information. My partner Mickey assured her that ointment was just as good as drops and she would be fine. I think the worst of it is now over...
I should have run!
She opens her folder with pages and pages of hand written notes about her eye issue from 1984. No, I'm not kidding. She tells me about EIGHT different medicines she was given for her eye condition in 1984 and how each one caused her some side effect or problem. She ended up going to three different doctors and finally ended up at a dermatologist who said she had ocular rosacea.
And so now the insanely tall woman starts grilling me about the ointment and what side effects she's going to experience. I counsel her as best I can, but there are a certain number of people out there that are just... how shall we say... sensitive to everything or think that every medication causes them an issue. I tell her that because of her past experience she will likely experience some side effect (who knows what) but that I think the doctor made the best decision with the ointment for her. She leaves, but I have a feeling there will be detailed notes added to her 2013 file with my name in it.
On a warm March mornin' in a pharmacy behind the counter,
I met up with the tall woman; with a red eye that would weep.
She continued askin' me questions
Until she allowed me to speak.
So I says, "Lady, I've made my life out of readin' people's faces,
And knowin' what their conditions are by what was in their eye.
So if you don't mind my sayin', conjunctivitis is your case,
You need an antibiotic for your eye, was my advice."
So she returned the next mornin' with a script for an ointment
She wasn't happy cause I told her to get some drops for her sight
I'm not an eye guy, but that ointment was just right,
If you're gonna take my advice, ya gotta learn to listen, alright!
You got to know when to hold 'em, know when to fold 'em,
Know when to walk away and know when to run.
You never fill a prescription when you're stuck at the register,
There'll be time enough for countin' pills when the counseling is done.
Now Ev'ry pharmacist knows that the secret to survivin'
Is knowin' what scripts to throw away and knowing which ones to fill.
'Cause ev'ry patient is a winner and ev'ry patient a loser,
And the best that you can hope for is to give them the right pills.
So when she finished grillin', she turned away from the window,
Closed up her 1984 folder and headed out of town.
And somewhere in the darkness, I know she'll be back...
My times a comin', she'll be back with a frown.
You got to know when to hold 'em, know when to fold 'em,
Know when to walk away and know when to run.
I'll know when to fill a prescription or when it's the right time,
To run out of that pharmacy before the countin' is done!
Wednesday, April 17, 2013
TOP DRUGS of 2012 at My Pharmacy
1. Zolpidem 10mg (Ambien generic -- for sleep)
2. Oxycodone/APAP 5/325 (Percocet generic -- for pain)
3. Fluticasone 50mcg (Flonase generic -- for seasonal allergies)
4. Azithromycin 250mg Z-Pack (antibiotic)
5. Fluvirin 2012-13 (flu shot)
6. Simvastatin 20mg (Zocor generic -- for cholesterol)
7. Amoxicillin/Clavulanic Acid 875mg (Augmentin generic -- antibiotic)
8. Hydrocodone/APAP 5/500mg (Vicodin generic -- for pain)
9. Cephalexin 500mg (Keflex generic -- antibiotic)
10. Lisinopril 10mg (Zestril generic -- for high blood pressure)
11. Lisinopril 20mg (Zestril generic -- for high blood pressure)
12. Oxycodone 30mg (for pain)
13. Endocet 10/325mg (Percocet generic -- for pain)
14. Sertraline 100mg (Zoloft generic -- for depression)
15. Tramadol 50mg (Ultram generic -- for pain, sleep)
16. Alprazolam 0.5mg (Xanax generic -- for anxiety)
17. Alprazolam 1mg (Xanax generic -- for anxiety)
18. Amoxicillin 500mg (antibioltic)
19. Crestor 10mg (for cholesterol)
20. Singulair 10mg (for seasonal allergies)
The numbers also indicate that my pharmacy dispenses the number two on the list (generic Percocet) more than one time per day. Cialis is more popular than Viagra.
So basically the population of patrons at my pharmacy is composed mostly of anxious people who can't sleep, get sick, have high blood pressure and high cholesterol, and are in whole lotta pain.
Tuesday, April 16, 2013
You Running Late?
It's Sunday morning and I'm opening the pharmacy. I'm always on time. But no matter how many years we've been here, people have it in their head that we open at the same time on Sunday as we do the rest of the week. We don't. We open TWO hours later. It's posted at both windows, on the front of the store, our business cards, and if you call the automated line it will tell you when we open too.
But it happens every Sunday I work. Either someone is there at the window waiting for me to pick up or someone wants to hand me a script thinking their going to get it filled in 3.5 minutes. "You running late?" is something I hear quite often. No, I'm not running late. I'm actually early, you dolt. But I can't say that. I just try to remind them that we open two hours later on Sunday.
The last time this happened a guy set his prescription on my cash drawer. I was carrying a bunch of stuff including the cash drawer and although it would have taken me maybe 30 seconds to open the door and put down the stuff, he couldn't wait that 30 seconds and set it on the cash drawer I was holding. I told him yes, I can fill it in 3.5 minutes but I'm going to need 10 minutes or so to fire up the ancient Windows computers and enter 47 passwords to get to a filling screen. That's why I'm there at least 15 minutes early. Keep in mind that's 15 minutes I do NOT get paid for. I'm giving the company a free 15 minutes because their computers are not right ready to go at the opening bell.
Sometimes I'm lucky and get into the pharmacy before someone is there, but then the next thing that happens is someone knocking on the window. It happens every Sunday I work without fail. Knock knock knock... "Are you in there, Danny Boy? Jack is here and I need my prescription pronto!"
And come to think of it now... pharmacy is pretty much like The Shining in a lot of ways... Let's explore this further:
* Pharmacists really don't have Shining, -- but prescribers and patients just expect us to be able to read their minds and hear their thoughts.
* When Wendy interrupts Jack, it's just like when a patient interrupts us counting their medication. We want to say, "Let me explain something to you. Whenever you come in here and interrupt me, you're breaking my concentration. You're distracting me. And it will then take me time to get back to where I was. You understand?" And just like Jack loses his mind by constantly getting interrupted, we pharmacists slowly lose our minds every time we're interrupted.
* The grocery is pretty much just like The Overlook... "We've got canned fruits and vegetables, canned fish and meats, hot and cold syrups, Post Toasties, Corn Flakes, Sugar Puffs, Rice Krispies, Oatmeal... and Cream of Wheat." And as the pharmacist, we're expected to know right where everything is!
* When a patient asks us to do something illegal or immoral, we feel like getting angry just like Jack and yelling, "Do you have the SLIGHTEST IDEA, what a MORAL AND ETHICAL PRINCIPLE IS, DO YOU? Has it ever occurred to you what would happen to my future, if I were to fail to live up to my responsibilities? Has it ever occurred to you? HAS IT?"
* If I dare to think I can get out of this hell hole, Grady will set me straight. "I'm sorry to differ with you sir, but YOU are the pharmacist. You've ALWAYS been the pharmacist!"
* And don't even ask me about trying to run prescriptions on insurance for twins!
So be NICE to your pharmacist because ALL WORK AND NO PLAY MAKES YOUR PHARMACIST A DULL BOY. REDRUM REDRUM REDRUM
Monday, April 15, 2013
Alienating the Left
Recently I posted another article about Levaquin Lady. Some readers took offense with the following statement from the article:
Levaquin Boy was feeling sorry for his mom at home. She was discharged early because of new hospital rules regarding reimbursement which are a direct result of major changes in healthcare, but I wouldn't want to point any fingers at the culprit because there's just soooo many readers of this blog out there that are quite happy with the way things are going healthcare-wise. Someone might say "Socialist Libtards," but I won't.
One comment states:
I used to think that your blog was semi-amusing, and I started reading it because it is on Dr. Grumpy's recommended list. The increasing number of bitter, insulting political comments have changed my opinion. It's your blog, your choice, but I'm not sure why you'd want to alienate left-leaning readers.
Semi-amusing? Woo hoo! Thank you! That's a big step up from my family members who don't find it amusing at all! But I have to ask: where have you been the past thirty years? The media in general, but primarily newspapers, television, and Hollywood, has been on an anti-conservative bent FOR YEARS. From digs on Dan Quayle to George W. Bush to John McCain, it's a never-ending saga of "bitter, insulting political comments." Every week on Saturday Night Live we're treated to some sort of dig on conservatives. I laugh at something when it is funny whether it is a dig at a liberal or a conservative. I laughed when they made fun of Dan Quayle. He said some wild crazy things and the media went out of their way to publicize it and make fun of it. TODAY you're hard pressed to hear about the stupid things that Joe Biden says all the time even though he says A LOT of stupid things. Just the other day Biden was telling people to use a shotgun instead of an assault rifle because it won't put holes in the wall. Really?
The irony is that my statement about the healthcare reforms in this blog article points out the fact that the new healthcare policy actually has a negative effect on the patient and is really all about money, not the patient. To me this would be something that a liberal would suggest as a conservative reform, not vice versa. Part of the healthcare reform (that Nancy Pelosi instructed the congress to vote for "so we can see what's in it") directly affects the reimbursement that hospitals receive for Medicare patients. One small part of that reimbursement is that the patient must be discharged according to the healthcare bill's predetermined chart, NOT based on when the individual patient should be discharged according to their own needs. OTHERWISE, the hospital does NOT get paid, at all. I'm sorry people don't seem to understand this simple concept, but ALL businesses operate on profit. No profit = no incentive to produce. Unless the hospital can make a profit, they're not going to stay in business.
Every patient is different and for all the Levaquin that Levaquin Lady has had in the past, kicking her out of the hospital too soon was a really bad idea. And here's another aspect you probably don't know about. When a patient is discharged according to this predetermined schedule, the new directives also dictate that IF the patient returns to the hospital within a certain amount of time with the same ailment, the hospital will not be reimbursed for EITHER visit. The healthcare directive is forcing hospitals to discharge patients early then if they come back due to complications being discharged early... tough luck, no reimbursement for you. Tell me, HOW is this beneficial? It's NOT, except to stick hospitals with having to spread the cost of these patients onto other patients' bills.
Over the next decade you will see massive changes in how care is provided based on this bill. Hospitals WILL close. Have you noticed how urgent care centers are popping up everywhere? That's because they know this. This is the future of healthcare. Doctors will stop taking Medicaid and Medicare patients because they won't be able to get paid for seeing these patients. Some doctors are already declaring bankruptcy. Read this article. Again, let me remind you, all businesses operate on profit. No profit = no incentive to produce.
You're kind of silly. The corporate blockheads are making your work life miserable because of their greed, yet you want healthcare completely in their hands? Not sure if I'm left or right, but I'd love to know what you think is the answer here.
I'm not silly. I am on the battle line seeing what's really happening as its happening. Nothing I said indicated that I want corporations to run healthcare, but I certainly don't think government should be involved in it either. One thing I know for sure: Socialism is not the answer. If you can tell me ONE example of anywhere in the world where socialism has worked, I'll reconsider. You can't. Look at history.
Janine said...
I have to agree with the other two posters. Clearly you hate the thought that the gov't might try to provide health insurance to those unable to afford it any other way, but I don't understand why. I also don't understand why you think it will make your life worse, since your problem seems to be that you hate the company you work for.
I don't hate the thought that the government might try to provide health insurance to those UNABLE to afford it any other way. What I see on a daily basis is massive abuse of the Medicaid system by people who ARE able to pay but are taking advantage of the system. Here's an EXAMPLE of how the you know the system is broken and is exactly what I'm talking about, and NO it isn't an isolated incident. Abuse of Medicaid happens all the time. There is a growing, pervasive ENTITLEMENT attitude out there of YOU owe ME and it just has to stop. This abuse is widespread and it costs us all money.
Also you overlook a very real problem in this country. For 15 years I was self-employed and bought my own health insurance. Then the recession hit, my income plummeted yet my health insurance had risen to $800/mo. I had no choice but to drop it (along with a host of other "necessary" things like collision on my car, healthy food, etc.). For 5 years I lived in fear of becoming really ill. No matter what might be wrong, I had to hope it would heal on its own because no doctor would even see me without insurance--and the ER is much too expensive for non-emergent issues. It's a horrible feeling to have to live with such fear. Recently I was able to again get health insurance for a price I could afford because I still spend NO MONEY on anything that isn't critical to existence, like food. No restaurants, newspapers, vacations, or unnecessary trips in the car. NOTHING. But I can afford health insurance again. Maybe your utter lack of compassion has something to do with the fact that while you don't like your job, it has always included some health insurance so you don't know what it's like to live in fear of dying of something easily curable just because no doctor will see you?
I am sorry for your situation but as you describe it you're one of a very few number of people using the system for the help it was designed for. You didn't abuse it and I don't mind a portion of my taxes going to people who truly need it and appreciate it. What I see is widespread abuse by people who take advantage of Medicaid and Medicare's lack of any ability to verify each patient situation. Too many people know that they can get help at no cost or virtually no cost just on a signature. And they DO take advantage of it.
I was self-employed for 20 years myself. I bought my own health insurance when I could afford it. I didn't always have health insurance and I paid out of pocket for the doctor/hospital cost for the birth of both of my children. I never thought that my healthcare was a "right" like life, liberty, and the pursuit of happiness, because it is not. I have a right to life, but I didn't (and still don't) expect my healthcare to be paid for by everyone else. That's the thing you have to realize... when people say THE GOVERNMENT is paying for Medicaid, that's not really true. Taxes from OTHER people are paying for Medicaid. I have no "right" to expect someone else to pay for my healthcare any more than I have the "right" to go to my next door neighbor and demand that he give me a gallon of gas out of his car because I'm short this week.
Maybe your utter lack of compassion has something to do with the fact that while you don't like your job, it has always included some health insurance so you don't know what it's like to live in fear of dying of something easily curable just because no doctor will see you?
And that's another thing: While I have health insurance, I don't have drug insurance because I only take one, inexpensive drug (synthetic/generic thyroid). But my local pharmacy chain charges me $30 for a month's supply, while WalMart charges me $4. So is WalMart subsidizing the other $26 in the hopes that I'll buy more than $26 worth of stuff while waiting for the prescription or is the chain ripping off those of us without insurance? What does it cost to make a thyroid pill? Something is seriously wrong with the way we do healthcare in this country and if there is any way that Omamacare will correct it, I'm all for it.
I don't know your community, of course. In mine, all the major pharmacies match the Walmart $4/month price for a bunch of medication, even if it is below cost. What's more, every pharmacy matches the other pharmacies' list. Each pharmacy has a different list, so in essence the actual list of medications available for $4 for a month supply is much larger than any one list. In some states they just give you an Amoxicillin Rx at no cost just to get you in the door.
Again, I don't know your specific pharmacy that's charging $30 for a month supply. But if we look at it under the idea that NO profit = no incentive to produce, it would make sense. Walmart is huge, the largest retailer in the world. And with that you get a huge, huge quantity discount. In retail, the more you buy, the cheaper the price. That's just the way it works. A small community pharmacy has to pay more for Levothyroxine (generic Synthroid) than Walmart. It's just a fact. A small community pharmacy has to pay more per square foot for rent. They have to buy their own insurance at a premium price (which you are aware of... you said you were self-employed). So EVERYTHING costs more for the small pharmacy as compared to Walmart. Do I think it justifies them charging $30 for a Levothyroxine Rx? I don't know. But I'm sure the manager/pharmacist there is simply trying to make a profit to feed his family based on income needed per number of prescriptions filled. What I can tell you is that you will get faster and better pharmacy service than at the giant Walmart where you're just an Rx number.
I recently transferred a couple of prescriptions from Walmart to my pharmacy. I was astounded at one of the labels on the bottle: "Please give us 48 hours advance notice for your refill." Really? 48 hours? I barely get 10 minutes advance notice at my pharmacy. Years ago I did a rotation at CostCo. Every single person that had to wait ten minutes JUST TO DROP OFF their prescription was absolutely shocked to hear that it was going to take 90 minutes to fill their prescription. And it did take 90 minutes with TWO pharmacists, NINE technicians, and me the intern to fill the prescriptions, because it was just that busy. Did we have time to really delve into the particulars of each patient? No. This was a pump-it-out factory of prescriptions.
Let's analyze the Levothyroxine issue for a moment. I don't have exact numbers, but we can estimate. Suppose your local pharmacy has one technician and one pharmacist. Let's further assume from start to finish it takes five minutes to fill your Levothyroxine prescription:
Technician, $10/hour, 5 mins = $0.83
Pharmacist, $52/hour, 5 mins = $4.33
bottle = $0.15
cap = $0.05
label = $0.20
product = $1.26
electricity, phone, rent, insurance... all fixed costs but would be part of the equation too. Let's say electricity is $300 per month, $100 for phone, rent is $2,000, insurance is $500. I'm pulling these numbers out of thin air but this is just for fun. Let's further say that your local pharmacy does 600 prescriptions a week or 31,200 prescriptions a year. So for every prescription, the fixed cost is about $.90 per Rx. We haven't even addressed any other staff for the pharmacy, promotion, advertising, even the bag to insert the Rx, etc.
So far I've got $7.72 as just the COST for processing your prescription. Remember, the pharmacy HAS to make a profit or he/she wouldn't be able to stay in business. If the pharmacy does a lot less than 600 prescriptions a week, obviously the cost is going to go up and the mark up has to be higher. So what's the trade off? Why is your prescription $30 instead of $4? Part of it is simply the cost of doing business. But why does your pharmacy continue to stay in business? Because he or she sells something that Walmart can't... that's genuine, personalized customer service. You're only on one med. But if you were on several meds its a good bet that even when the computer picks up on an interaction at Walmart they will bypass it and you'll not be counseled at the register. But not an your local pharmacy. Maybe 90 minutes isn't unreasonable to you, nor is having to let the pharmacy know 48 hours ahead of time. Maybe $30 is unreasonable for one Levothyroxine prescription... but when you look at it, really look at the numbers involved you can see that it is much more than that. Your local pharmacy will never be able to compete with giant Walmart ON PRICE alone. If that's the only thing that's important to you, then you'll never understand the value of an educated and seasoned pharmacist.
Levaquin Boy was feeling sorry for his mom at home. She was discharged early because of new hospital rules regarding reimbursement which are a direct result of major changes in healthcare, but I wouldn't want to point any fingers at the culprit because there's just soooo many readers of this blog out there that are quite happy with the way things are going healthcare-wise. Someone might say "Socialist Libtards," but I won't.
One comment states:
I used to think that your blog was semi-amusing, and I started reading it because it is on Dr. Grumpy's recommended list. The increasing number of bitter, insulting political comments have changed my opinion. It's your blog, your choice, but I'm not sure why you'd want to alienate left-leaning readers.
Semi-amusing? Woo hoo! Thank you! That's a big step up from my family members who don't find it amusing at all! But I have to ask: where have you been the past thirty years? The media in general, but primarily newspapers, television, and Hollywood, has been on an anti-conservative bent FOR YEARS. From digs on Dan Quayle to George W. Bush to John McCain, it's a never-ending saga of "bitter, insulting political comments." Every week on Saturday Night Live we're treated to some sort of dig on conservatives. I laugh at something when it is funny whether it is a dig at a liberal or a conservative. I laughed when they made fun of Dan Quayle. He said some wild crazy things and the media went out of their way to publicize it and make fun of it. TODAY you're hard pressed to hear about the stupid things that Joe Biden says all the time even though he says A LOT of stupid things. Just the other day Biden was telling people to use a shotgun instead of an assault rifle because it won't put holes in the wall. Really?
The irony is that my statement about the healthcare reforms in this blog article points out the fact that the new healthcare policy actually has a negative effect on the patient and is really all about money, not the patient. To me this would be something that a liberal would suggest as a conservative reform, not vice versa. Part of the healthcare reform (that Nancy Pelosi instructed the congress to vote for "so we can see what's in it") directly affects the reimbursement that hospitals receive for Medicare patients. One small part of that reimbursement is that the patient must be discharged according to the healthcare bill's predetermined chart, NOT based on when the individual patient should be discharged according to their own needs. OTHERWISE, the hospital does NOT get paid, at all. I'm sorry people don't seem to understand this simple concept, but ALL businesses operate on profit. No profit = no incentive to produce. Unless the hospital can make a profit, they're not going to stay in business.
Every patient is different and for all the Levaquin that Levaquin Lady has had in the past, kicking her out of the hospital too soon was a really bad idea. And here's another aspect you probably don't know about. When a patient is discharged according to this predetermined schedule, the new directives also dictate that IF the patient returns to the hospital within a certain amount of time with the same ailment, the hospital will not be reimbursed for EITHER visit. The healthcare directive is forcing hospitals to discharge patients early then if they come back due to complications being discharged early... tough luck, no reimbursement for you. Tell me, HOW is this beneficial? It's NOT, except to stick hospitals with having to spread the cost of these patients onto other patients' bills.
Over the next decade you will see massive changes in how care is provided based on this bill. Hospitals WILL close. Have you noticed how urgent care centers are popping up everywhere? That's because they know this. This is the future of healthcare. Doctors will stop taking Medicaid and Medicare patients because they won't be able to get paid for seeing these patients. Some doctors are already declaring bankruptcy. Read this article. Again, let me remind you, all businesses operate on profit. No profit = no incentive to produce.
You're kind of silly. The corporate blockheads are making your work life miserable because of their greed, yet you want healthcare completely in their hands? Not sure if I'm left or right, but I'd love to know what you think is the answer here.
I'm not silly. I am on the battle line seeing what's really happening as its happening. Nothing I said indicated that I want corporations to run healthcare, but I certainly don't think government should be involved in it either. One thing I know for sure: Socialism is not the answer. If you can tell me ONE example of anywhere in the world where socialism has worked, I'll reconsider. You can't. Look at history.
Janine said...
I have to agree with the other two posters. Clearly you hate the thought that the gov't might try to provide health insurance to those unable to afford it any other way, but I don't understand why. I also don't understand why you think it will make your life worse, since your problem seems to be that you hate the company you work for.
I don't hate the thought that the government might try to provide health insurance to those UNABLE to afford it any other way. What I see on a daily basis is massive abuse of the Medicaid system by people who ARE able to pay but are taking advantage of the system. Here's an EXAMPLE of how the you know the system is broken and is exactly what I'm talking about, and NO it isn't an isolated incident. Abuse of Medicaid happens all the time. There is a growing, pervasive ENTITLEMENT attitude out there of YOU owe ME and it just has to stop. This abuse is widespread and it costs us all money.
Also you overlook a very real problem in this country. For 15 years I was self-employed and bought my own health insurance. Then the recession hit, my income plummeted yet my health insurance had risen to $800/mo. I had no choice but to drop it (along with a host of other "necessary" things like collision on my car, healthy food, etc.). For 5 years I lived in fear of becoming really ill. No matter what might be wrong, I had to hope it would heal on its own because no doctor would even see me without insurance--and the ER is much too expensive for non-emergent issues. It's a horrible feeling to have to live with such fear. Recently I was able to again get health insurance for a price I could afford because I still spend NO MONEY on anything that isn't critical to existence, like food. No restaurants, newspapers, vacations, or unnecessary trips in the car. NOTHING. But I can afford health insurance again. Maybe your utter lack of compassion has something to do with the fact that while you don't like your job, it has always included some health insurance so you don't know what it's like to live in fear of dying of something easily curable just because no doctor will see you?
I am sorry for your situation but as you describe it you're one of a very few number of people using the system for the help it was designed for. You didn't abuse it and I don't mind a portion of my taxes going to people who truly need it and appreciate it. What I see is widespread abuse by people who take advantage of Medicaid and Medicare's lack of any ability to verify each patient situation. Too many people know that they can get help at no cost or virtually no cost just on a signature. And they DO take advantage of it.
I was self-employed for 20 years myself. I bought my own health insurance when I could afford it. I didn't always have health insurance and I paid out of pocket for the doctor/hospital cost for the birth of both of my children. I never thought that my healthcare was a "right" like life, liberty, and the pursuit of happiness, because it is not. I have a right to life, but I didn't (and still don't) expect my healthcare to be paid for by everyone else. That's the thing you have to realize... when people say THE GOVERNMENT is paying for Medicaid, that's not really true. Taxes from OTHER people are paying for Medicaid. I have no "right" to expect someone else to pay for my healthcare any more than I have the "right" to go to my next door neighbor and demand that he give me a gallon of gas out of his car because I'm short this week.
Maybe your utter lack of compassion has something to do with the fact that while you don't like your job, it has always included some health insurance so you don't know what it's like to live in fear of dying of something easily curable just because no doctor will see you?
As I said, I was self-employed too. I lived in fear too. I can sympathize with your situation because I lived it myself. BUT I didn't expect someone else to pay for my healthcare. I honestly am just appalled at this philosophy. It really makes no sense to me. Further, it is very ironic that you accused me of having an "utter lack of compassion" when I was lamenting the fact that Levaquin Lady was discharged BEFORE she should have been. I was showing one weakness in Obamacare that directly affects the patient and the hospital.
And that's another thing: While I have health insurance, I don't have drug insurance because I only take one, inexpensive drug (synthetic/generic thyroid). But my local pharmacy chain charges me $30 for a month's supply, while WalMart charges me $4. So is WalMart subsidizing the other $26 in the hopes that I'll buy more than $26 worth of stuff while waiting for the prescription or is the chain ripping off those of us without insurance? What does it cost to make a thyroid pill? Something is seriously wrong with the way we do healthcare in this country and if there is any way that Omamacare will correct it, I'm all for it.
I don't know your community, of course. In mine, all the major pharmacies match the Walmart $4/month price for a bunch of medication, even if it is below cost. What's more, every pharmacy matches the other pharmacies' list. Each pharmacy has a different list, so in essence the actual list of medications available for $4 for a month supply is much larger than any one list. In some states they just give you an Amoxicillin Rx at no cost just to get you in the door.
Again, I don't know your specific pharmacy that's charging $30 for a month supply. But if we look at it under the idea that NO profit = no incentive to produce, it would make sense. Walmart is huge, the largest retailer in the world. And with that you get a huge, huge quantity discount. In retail, the more you buy, the cheaper the price. That's just the way it works. A small community pharmacy has to pay more for Levothyroxine (generic Synthroid) than Walmart. It's just a fact. A small community pharmacy has to pay more per square foot for rent. They have to buy their own insurance at a premium price (which you are aware of... you said you were self-employed). So EVERYTHING costs more for the small pharmacy as compared to Walmart. Do I think it justifies them charging $30 for a Levothyroxine Rx? I don't know. But I'm sure the manager/pharmacist there is simply trying to make a profit to feed his family based on income needed per number of prescriptions filled. What I can tell you is that you will get faster and better pharmacy service than at the giant Walmart where you're just an Rx number.
I recently transferred a couple of prescriptions from Walmart to my pharmacy. I was astounded at one of the labels on the bottle: "Please give us 48 hours advance notice for your refill." Really? 48 hours? I barely get 10 minutes advance notice at my pharmacy. Years ago I did a rotation at CostCo. Every single person that had to wait ten minutes JUST TO DROP OFF their prescription was absolutely shocked to hear that it was going to take 90 minutes to fill their prescription. And it did take 90 minutes with TWO pharmacists, NINE technicians, and me the intern to fill the prescriptions, because it was just that busy. Did we have time to really delve into the particulars of each patient? No. This was a pump-it-out factory of prescriptions.
Let's analyze the Levothyroxine issue for a moment. I don't have exact numbers, but we can estimate. Suppose your local pharmacy has one technician and one pharmacist. Let's further assume from start to finish it takes five minutes to fill your Levothyroxine prescription:
Technician, $10/hour, 5 mins = $0.83
Pharmacist, $52/hour, 5 mins = $4.33
bottle = $0.15
cap = $0.05
label = $0.20
product = $1.26
electricity, phone, rent, insurance... all fixed costs but would be part of the equation too. Let's say electricity is $300 per month, $100 for phone, rent is $2,000, insurance is $500. I'm pulling these numbers out of thin air but this is just for fun. Let's further say that your local pharmacy does 600 prescriptions a week or 31,200 prescriptions a year. So for every prescription, the fixed cost is about $.90 per Rx. We haven't even addressed any other staff for the pharmacy, promotion, advertising, even the bag to insert the Rx, etc.
So far I've got $7.72 as just the COST for processing your prescription. Remember, the pharmacy HAS to make a profit or he/she wouldn't be able to stay in business. If the pharmacy does a lot less than 600 prescriptions a week, obviously the cost is going to go up and the mark up has to be higher. So what's the trade off? Why is your prescription $30 instead of $4? Part of it is simply the cost of doing business. But why does your pharmacy continue to stay in business? Because he or she sells something that Walmart can't... that's genuine, personalized customer service. You're only on one med. But if you were on several meds its a good bet that even when the computer picks up on an interaction at Walmart they will bypass it and you'll not be counseled at the register. But not an your local pharmacy. Maybe 90 minutes isn't unreasonable to you, nor is having to let the pharmacy know 48 hours ahead of time. Maybe $30 is unreasonable for one Levothyroxine prescription... but when you look at it, really look at the numbers involved you can see that it is much more than that. Your local pharmacy will never be able to compete with giant Walmart ON PRICE alone. If that's the only thing that's important to you, then you'll never understand the value of an educated and seasoned pharmacist.
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