Wednesday, August 26, 2020

Random Text Fun

Do you ever get a random text from someone who is texting the wrong number... but instead of texting back “Hey wrong number,” you go ahead and keep the conversation going as long as possible?

I did, recently. I couldn't help myself. The potential for comedy was just too enticing. Sadly, it didn't last long, but it still ended up funny.

It was quiet on my side for a little while... maybe 30 minutes or so... then finally I received a response:

Sadly, my trolling for some of the real wedding pictures was left unanswered.

When you're a pharmacist and you get beat down, every single day by patients, physicians, and the company you work for, you seek out these outrageous moments to decompress. 

Hopefully my little bit of fun made you laugh.

Monday, March 2, 2020

So the Truth FINALLY Emerges about GoodRx

Consumer Reports recently published an article about GoodRx. Their research indicates that people do save money. That was never in question with me. I've seen people save a whole $1.80 all the time. Woo hoo!

My issue has always been that this company, the GoodRx company, has never been honest with people about what they do with the private and personal medical information they capture and store EVERY TIME someone uses the GoodRx billing information for a prescription.

As Consumer Reports found out, they've been quietly selling that information to various companies, including Google and Facebook. Oh, excuse me... that they've been SHARING. You know, just like when you go see a movie at the movie theater... you share a $20 bill with them and then they share the movie with you by showing it to you... that kind of "sharing."
And if you'll look at the GoodRx company website, they also updated their privacy policy... yet again. They updated it a couple of years ago after I pointed out that they consider your data their asset, and now they've decided to update the policy again after the Consumer Reports article.

Oh, they also fired their Vice President of Data Privacy. He and his cardboard box with a picture of the wife and kids and his potted plant were escorted out of the building immediately... taking the fall, of course, for not doing a better job of hiding what they do over there at the data collection center.

Hopefully this article will make some people finally wake up about their data privacy. We can hope, anyway. I get asked all the time why I have such a beef with GoodRx and other pharmacy "coupons" offered by various companies. The entire idea of a pharmacy coupon bothers me for a number of reasons:

Pharmacists provide a professional service. Lawyers don't offer coupons. Doctors don't offer coupons. The whole idea reduces us to nothing more than carnival barkers fighting for customers over price. We're not really just taking tablets out of a bigger bottle and putting them into a smaller bottle. We check for interactions with the patient's other meds, make sure it is safe, correct, the right dosage, etc. People typically pay their attorney $5 a minute... yes, that's $300 an hour, to represent them in court... because there is an expectation there that the lawyer will check everything out and make sure every angle is covered. Yet asking $300 for a LIFE SAVING medication that has been correctly researched and made sure it's safe for the patient is somehow unreasonable?

It's unfortunate that medications are expensive. I don't like it any more than anyone else. Yet when you back up and look at the whole picture; medications cost money because it's hugely expensive to create them and test them and make sure they're safe for the patient. It takes 12 years from when a medication is identified before it makes it to market. That's 12 years of research and development and all the costs associated with testing it BEFORE the company makes a single dime on any of it. AND when you consider that the patent is going to run out fairly quickly AFTER those 12 years, the company that did all the R&D and testing is not going to have very long to make any money off the drug before other companies enter the market. The high price is simply the return on a huge investment. I can understand the high cost of brand medication from a business standpoint.

"But other countries sell the same medication for less," people retort. Yes, they do. But that's because the country itself controls the market. The prices are set before the medication enters the country. In effect, we in the United States end up subsidizing medication outside the country by paying more so they can pay less. That's not fair either, but just the way it is. You're certainly free to move to another country where the price is less.

I get comments on my blog posts all the time... such as "I saved $700 on my medication using GoodRx." No, you really didn't, but they made you think you did. I'm sure there's some outliers that save much more than the LISTED cash price. But every pharmacy I've ever been to has an in-house discount. No one needs to pay the LISTED cash price. The "80% savings" is a lie. Making it look like the pharmacist just types it into the cash register is a lie. Making it look like it just takes seconds to get a better price is a lie. It's all a lie, brought to you by a company that's been called out for telling you that they don't share your private medication information.

That's the biggest problem I have with discount cards, and GoodRx specifically, is that that outright lie to people about data collection. People are so impressed to save a few bucks that they gladly hand over their private, personal, ain't-nobody's-business medical information each and every time they use GoodRx. People simply don't understand what they're giving up because all they see is the out of pocket cost at the moment. I just don't understand why people would think that a coupon is going to save them 80% on a medication without there being some sort of payback somewhere. They think it's a magic button. Press it and the price drops by 80%. Really? How stupid are you?

Some day, some day soon, people will start getting insurance denials of service or future coverage... because of "inferred" disease states or conditions they listed in their fine print... which was based on data collected by GoodRx. Other people will see their credit scores go down because the creditors will know what medications they take, some of which will be considered "high risk" medications. Employers will weed out applications for employment when they can easily buy a database from GoodRx and look up the medical history of a patient and see that if they hired the applicant it would cost them more to insure them. Oh wait, excuse me.... when GoodRx shares that information with them.

It isn't like that now... but it will be. Wait and see. It will happen. Wait and see. I've interviewed former employees of GoodRx. I'm fully aware of how valuable they know their data collection is to them. They have a team of data-mining engineers massaging the data as I'm typing this. I've exchanged barbs with the CEO of GoodRx on Twitter. After our public tweets were exchanged, they changed the wording on their website... days after I called them out on storing data. The CEO blocked me and freely tweets that I physically threatened him and his family. That never happened. Another lie. A creepy lie.

If you're not aware of how Facebook works, let me fill you in. You're the product. Every time you hit LIKE on anything, or even click on anything, that information is captured, stored, and used in algorithms to feed you future information based on that click. You will see ads targeted to sell you things based on a "profile" they create about you. That data is also sold to various companies. Oh wait, no, they share it. It's SHARED with other companies.

What you may not know is that Doug Hirsch, the CEO I just mentioned and one of the founders of GoodRx, STARTED at Facebook where he learned these data collection skills and copied it into the GoodRx platform -- data collection for profit. Put it all together and it's so very clear what's going on, yet people are just stuck on saving a few bucks today and giving up their privacy forever.

If a company wants to offer discounts for medications for patients, go for it. Just leave the retail pharmacy out of it. Work it out with the patient BEFORE they get to the pharmacy like Blink does, or AFTER they've left the pharmacy in terms of a reimbursement or refund. Make it different enough NOT to affect pharmacy operations at all and I can guarantee you that pharmacists and techs will dispense your discount plans for you everywhere. If you make it so we have to put in a BIN, PCN, Group, and ID number, you've pissed us off. We don't have time for that. 

I simply can't tell you the time and effort I've personally wasted messing with discount cards IN the pharmacy... TIME we need to fill prescriptions and make sure they're safe and correct for the patient. We fill the medications. The price of the medication is something we shouldn't have to deal with at all. The doctor doesn't handle billing for his or her services. We shouldn't either. You pay, either by insurance or cash. Let us be pharmacists, not carnival barkers.

Wednesday, November 13, 2019

I've Had Enough

The Crazy RxMan has had enough of retail. It beat me. I'm done. Finished. Defeated. The fat lady is singing.

No matter how hard I tried, the upper management at Goofmart Pharmacy just kept knocking me down. Increased vaccine goals, other pharmacists stabbing each other in the back, good techs quitting, additional responsibilities with no extra help... you name it, it has happened. And it's all driving me away.

Goofmart Pharmacy is a company that won't exist in twenty years, maybe not even ten years. It will either be sold to a major chain (like Target did with CVS) or abandoned altogether (like my friends inside Walmart Pharmacies tell me they're considering). There's no money to be made in grocery store pharmacy unless you're GoodRx or a PBM or the guys that make the signage and buttons for flu shots. (Funny how management always seems to have money for promotional material but never any money for extra help... that would have made a good blog post, but I just don't care anymore).

The reduction in pay and/or hours was the first wave of "strategic management" and the first sign of a dying business. It wasn't the first red flag, but it was the biggest so far. When a business starts cutting the work force, reducing hours, closing stores... that's the beginning of the end. It happened with Blockbuster, Radio Shack, Montgomery Ward's, and Sears. When a business reaches that point it's in a death spiral.

So when they cut me back to 32 hours I knew what to do. That's when I started looking for other employment full time on my days off. There will be more cuts and more demands from upper management. Recently at Goofmart they've decided if you don't reach a certain number of vaccinations in a specific period, you get a write up on your record.

That's the smell of desperation, folks.

Can you believe it? What was once an honored professional medical position is nothing more than a sales position now. Don't meet the quota? You're out of here, just like the car salesman that didn't sell enough cars. We don't care if you're a doctor of pharmacy. If you're not selling enough flu shots you're not going to stay here.

I really and truly loved helping people... the ones that were appreciative and kind. As time when on, there were fewer and fewer of those people, replaced with entitled snobs who quickly learned they could get whatever they wanted by threatening to make a complaint.

I have become abrasive and short with the people giving me a constant barrage of nonsense. I'm physically tired from all the extra time I put in for free just to keep up with the queue. I would get physically ill on Monday mornings knowing I'll not only have to deal with Monday nonsense but also knowing that I'll be working with a pharmacy manager who is hell bent on seeing me fired.

Seeing Walmart and Walgreens squirm like a toad on the asphalt on a hot summer day in Phoenix is yet another big red flag. The days of retail pharmacy are coming to a close. CVS knows it and that's why they're copying Amazon's PillPack model. Walgreens might survive getting bought up by KKR, but one thing we know for sure is that grocery pharmacy is done.

The grocery store pharmacy model won't survive. There won't be enough business with just antibiotics and urgent eye medications to make it long term. And weak attempts to enter the medication delivery business won't match the logistics of Amazon. Oh, they're worried about the storm that Amazon is about to unleash, but they have no idea that it's the storm of the century. Amazon is about to bury you.

It's really over, my fellow pharmacist. If you work in a grocery store pharmacy or retail in general, consider your options, my friend. Consider your options.

Saturday, July 27, 2019

10 Reasons WHY your Pharmacist HATES GoodRx

1. GoodRx calls it a “coupon” — like it’s a barcode we scan at the register and it takes money off a prescription co-pay like a grocery coupon works at the register. They even show a commercial suggesting that’s how it works and that it takes only seconds. It doesn’t work that way. We have to reverse the billing we’ve done, enter in the information like an insurance card, rebill, and print new paperwork. This is extremely tedious and time-consuming, especially when people are in line at the register. 

2. When you use GoodRx, you're trading your personal and private health information for what amounts to a few bucks in savings for almost all transactions. Do you want your employer, or your insurance company, or anyone else to know you’re on anti-depressants, HIV medication, Viagra, or that you regularly get medication for genital warts? When you use GoodRx, ALL that data regarding your prescription transaction is collected and stored. GoodRx employs people to dig into it analyze it. And they use and sell that data. At one time they printed on their website that they consider your data an asset and if/when they sell their company YOUR PRIVATE DATA gets sold too. 

3. GoodRx prints a regular card with billing info on it which gives one discount then if you go to their website and put in the specific drug name you get an even deeper discount. Why is that? Because they’ve captured a specific instance of all your demographic information attached directly to the medication you had filled. This is a gold mine for them so they give a better discount. 

You also have to understand that at the pharmacy this is yet another billing nightmare. The patient gets the card handed to them by the physician or they get one in the mail and they hand it to us. So we use that billing. THEN at the register the patient pulls up the app and sees a price they expect to get at the register. When it doesn't match the pharmacy has to start all over. This wastes EVERYONE's time!

4. Using GoodRx fragments healthcare. People often get multiple prescriptions from their physician and then when they get specific GoodRx prices for each of the meds the best prices are most often not all offered at the same pharmacy. People will take each prescription to a different pharmacy to get the best GoodRx price. This is DANGEROUS! No one pharmacy knows exactly what the patient is taking and we have no idea if there are any interactions or issues. Fragmentation in healthcare is a SERIOUS problem. See this LINK.

5. GoodRx destroys the professionalism of Pharmacy. Your pharmacist provides a professional service. We went to years of schooling to keep you safe and make sure your prescriptions are correct, safe, and appropriate for you. GoodRx turns it into a cheap circus show of carnival barking where the only thing that matters is a few bucks. 

6. GoodRx takes precious time away from the pharmacy. We’re already strapped for time and GoodRx only makes it worse. Imagine you’re shopping on Amazon. Further suppose Amazon required you to put in your credit card billing information not only for every time you made a purchase but also for every single separate item you purchased online? A little tedious? You bet! And that’s the best way to describe what’s happening when you use GoodRx. The result of all this time we spend on GoodRx billing reduces the time for filling medications— so we have to speed up to keep up! And that too is DANGEROUS! Are you really ok that we are pressed for time filling your child’s antibiotic medication so someone else can save a few bucks?

7. GoodRx has people so brainwashed they insist we try it even when we already know the price will be better on their insurance. People no longer believe us and make us go through the tedious nonsense just to prove it to them. 

8. GoodRx takes money away from the pharmacy that fills the prescription. Part of the “amazing” savings is just lopped off the reimbursement the pharmacy receives. And when pharmacies make less money they turn to cutting pharmacist and tech hours at slower stores. You may save a few bucks on a prescription but overall you’re hurting the lives of the very people filling your prescription. See LINK.

9. GoodRx has infiltrated physician offices and have doctors and their staff convinced they're doing a good thing for their patients when they’re not. Moreover, we at the pharmacy would never tell a patient what their doctor's office visit should cost them. Yet physicians consistently pass out GoodRx cards to patients. This is the utmost in disrespect. 

10. GoodRx changes prescription filling from being centered around healthcare to being all about cost. I literally have patients every day more concerned (and in some cases totally consumed) about whether their prescription was run on GoodRx instead of having any interest in learning how to take the medication and what to look for with side effects. This too is INCREDIBLY DANGEROUS! Saving money is nice, but knowing how to take your medication and what to watch out for is much more important, don't you think?

Thursday, July 4, 2019

Where is the Crazy RxMan?

I'm still here.

Life has been extremely crazy even for a guy who calls himself the Crazy RxMan.

My hours as staff pharmacist were cut to 32 a week. Upper management thinks that chopping several pharmacists' salaries by 20% is perfectly reasonable. It's not ok. We have kids. Some of mine are in college. And most of us still have school loans. I pay more each month in school loans than most Americans pay for their mortgage.

So yeah, I wasn't happy about the change.

But I was told I was the only one out of 200 stores in our division that complained.

Meanwhile some that were cut left the sinking ship to find other positions with other companies in a market where it's already hard to find a pharmacist job.

The rest of us scrambled around finding positions in the company with 40 hours a week. I was lucky and transferred to another staff pharmacist position with 40 hours.

And just when you thought I hated Snootyville, now it's even worse. This location is 50% busier than my last location with only 20% more tech help. My plea for more tech help was quickly beat down. I was told we have plenty of tech help. We're just inefficient.


The phones are ringing. People are waiting at both windows. I'm trying to reprocess someone's prescription on GoodRx (for an amazing $2.08 savings) while waiting on hold to get billing information for another patient who doesn't think it's her job to have her billing information with her. And yes, she's a Medicaid recipient. Another waiter has come up to the window while another patient is there at the window to tell me "You have several people in line now" (like I didn't know that). One of the callers is the corporate office asking me why I haven't done this week's MTM list. The other caller is someone wanting to know what "Refill: 0" means on their bottle.

But it's not a labor issue. It's an efficiency issue.

I hate my job. I hate the company. I hate the people who kept opening more and more pharmacy schools and flooded the market with hundreds of pharmacists who are willing to work for 20-30% less than we made just ten years ago.

As pharmacists we no longer have any control. One bad complaint and you're on a list. A few more check marks on the list and then you're canned and replaced by a new grad willing to work 60-70 hours a week and get paid for 40 hours at a rate less than what we were making ten years ago.

We used to be respected. We had professional jobs. We used to be the most trusted health care professional. 

Not anymore. All we are now are monkeys that work and work and work with no break and no lunch and make tons of money for GoodRx and the PBMs. 

This is the dark ages for pharmacy. We seriously need to band together and do something to save what's left of our careers. 

But it may be too late.

Monday, May 13, 2019

A Stab in the Back

In many states all across the nation, national pharmacy chains have reduced their pharmacists' hourly wage. But by far the biggest thing happening is that pharmacist hours are being reduced from 40 hours a week to 32. Slice it any way you want: It amounts to a 20% pay cut.

I recall the conference call at Goofmart Pharmacy very well. The director started off by saying how proud he is of all of our pharmacists for how hard we're all working. Then he went on to say that big changes are two weeks away and wanted to assure us that the changes were in no way a reflection on the financial stability of the company itself.

Then he rolled out the plan: Cut the hours open at slower stores and reduce the staff pharmacist position to 32 hours a week. The floor was then opened for questions. No one had any questions because we were all stunned. I know my mouth was hanging open.

After years, YEARS of loyalty working for Goofmart Pharmacy, I'm now being told that my wages were suddenly being cut by 20%. Fear flooded by body as I realized that all my obligations... house payment, car payment, kids in college, bills to pay, and retirement were now all in crisis. I just sat there, in shock, as I'm sure everyone else was.

I've written before about how the market is flooded with pharmacists and I'm sure simple supply and demand weighs into this, but I'm more convinced that the profit of pharmacies everywhere, affected by Pharmacy Benefit Managers (PBMs) is also hugely responsible for this nonsense. Upper management signs off on deals for razor thin profits without thinking how it will really play out in the trenches. Based on all the other amazingly stupid ideas they roll out, I wouldn't be surprised.

My gut feeling, though, tells me that at my company this is more about taking advantage of a situation in the marketplace. Upper management saw an opportunity to stick it to the pharmacists simply because other companies are doing it. I can't go into details, obviously, but I can tell you that Goofmart Grocery implements and copies their competition, implementing new policies and procedures, only because the other grocery store is doing it. 

And to me, that's just a stab in the back. Thousands of pharmacists, some with new families, others with kids in college, with house payments, car payments, and desperately trying to save for retirement have been stabbed in the back by the company they worked so hard for... hours upon hours up and beyond the 40 hours they've been paid each week.

I'm not alone. Look at this poll I ran on Twitter:

Almost 60% feel the same way I do: This is nothing more than a stab in the back. People are struggling with it, like me, and some of us feel like it truly is the end of our careers as pharmacists.

A few weeks after this new policy was implemented, the RPM was at my store for a routine visit and to tell us about a new gift card for transfer program. The new program was to give a $25 gift card for EVERY transfer... NO LIMIT. If someone has ten transfers, they get $250. No restrictions. 

So I had to ask the RPM... how is it that the company has money to throw around for gift cards for transfers but had to cut pharmacist hours?

Upper management anticipated this question well in advance and she rattled off the chosen reply off her lips quite readily:

"It's to increase script count so we can get our stores up the amount of scripts needed to get the staff pharmacists back up to 40 hours again."

I could almost picture her in front of her mirror that morning practicing delivery of that lie.

I stared at her for a moment. She's become so accustomed to lying to people that her tell was almost imperceivable. But I guess upper management doesn't realize that we see narc addicts lie to us on a daily basis and we're experts at seeing lies. She could sense I was seeing through the lie and changed the subject.

I let her continue for a few minutes, then mentioned how I had personally noticed how the daily emails from the scheduler had increased as open shifts were listed everywhere. I asked how they were dealing with the crisis.

"What crisis?" she asked.

"I heard a lot of pharmacists have left the company in search of 40 hour a week jobs and there's a lot of chaos as others are scrambling for the hours that are left."

"Oh no. There's no problem. The change was well-received..."

And then she looked me straight in the eye and said...

"You're the only one that's complained about the hour change."

How one says such a lie is beyond me. Hundreds of pharmacists just had their pay cut by 20% and I'm the ONLY one with a problem with it? And she seriously expected me to buy that lie?

This isn't over, folks. In the next few weeks I plan to discuss what I'm going to do about it. Hopefully there will be enough interest with others to save our careers. One man alone can't do it, but all of us together CAN do something.

Stay tuned....

Monday, April 22, 2019

The No-Win Scenario

It's inevitable. At some point in your pharmacy career, you will be faced with the no-win scenario... your own Kobayashi Maru.

It happened to me recently. I muddled through it, but the consequences have yet to be determined. At some point I'm sure this will reflect negatively on my career. 

But there was nothing I could do. There was no way to win. 

Let me explain the situation...

Patient Number One: An elderly, dignified lady there to pick up medications for her and her daughter. She happens to be black, and that's part of the story.

Patient Number Two: A complete jerk about age 40, never ever happy with pharmacy service at our pharmacy. One time he came to the pharmacy when I was sitting IN A CHAIR typing scripts and tech was sitting IN A CHAIR taking a break. The jerk wasn't happy that he wasn't helped within five seconds and made a complaint with upper management. The next day all the chairs disappeared from the pharmacy. I should also add that this jerk has made a number of racial slurs on occasion.

The Scenario: The elegant lady steps up to the counter to get her medication. She's clearly next in line as we have a workflow direction from start to finish... a "start here" sign AND an "exit here" sign. Only an imbecile of epic proportions would ignore the signage.

Seconds after the lady steps up to get her medication, Imbecile Jerk steps past the "exit here" sign and stands right next to the lady. I mean he's RIGHT NEXT to her, invading her personal space. She then looks uncomfortable because it IS uncomfortable. He's trying to push his way into being first or bully her.

In a split second my mind considers the possible outcomes of this encounter. 

* I tell the lady that Imbecile Jerk is next and that I'll be with her in a moment. Then she'll think I'm a racist when she was clearly next in line. This will affect all future interactions with this lady. I'll be branded as a racist when I'm not and race relations in the United States will continue to decline. 

* I tell the Imbecile Jerk that he needs to step over to the "wait here to protect patient privacy" which will infuriate him. He will think I'm putting her ahead of him. And HE WILL complain. In a normal world an upper manager would listen to my side of the story and dismiss the complaint. But we don't live in a normal world. We live in a world where upper management is also populated by imbeciles that accept any complaint at face value despite how preposterous it is.

* The lady and Imbecile Jerk interact and argue over who was next, causing Imbecile Jerk to throw out racial slurs and the whole thing will just be horribly ugly and at some point in the future I'll end up signing another warning letter because upper management will say it's all my fault.

I'm not Captain Kirk and I have no way of reprogramming the situation. In the split second my pulse quickens and I feel sick knowing there is no way to win. Oh why, or why did I choose a career working with the public? Why? Why have I chosen this constant daily punishment? 

In that moment of dread and fear I decide to do the only thing I felt I could do. I lied. I broke a commandment. Angels in heaven recorded it. Satan smiled as he prepared a special room for me in hell.

I told the lady that I was still working on filling her prescription and that I'd have it ready in a few minutes. She looked a little disappointed but mostly relieved to get away from Imbecile Jerk standing next to her.

I quickly grabbed the jerk's medication off the shelf. It's a zero co-pay because he's on Medicaid and he's off without saying anything (or signing our signature capture device because he refuses every time). Thank the old gods and the new ones in Westeros because Imbecile Jerk is gone.

When the lady returns I apologize for the behavior of the man that stepped up right next to her. I told her that the guy "has issues" (which isn't a lie -- he's a total psycho) and doesn't understand personal space. She was understanding and nice about it.

So did I win the No-Win Scenario? Maybe. But based on the bad luck I've had so far in this job I'm sure there's something about this encounter that will bite me in the butt eventually.