Wednesday, December 31, 2014

Someone Explain it to Me

Sometimes I'm alone in the pharmacy and when people line up to drop off prescriptions, each person is told a time until it will be ready. As the number of scripts dropped off increases, so does the time needed to fill the next one, obviously. The last person in line sometimes will have seen five or more people drop off new prescriptions ahead of them without my moving from the drop off window. When I tell them it may be up to an hour (depending on the situation), they always, ALWAYS say, "An hour? Really?" What were they thinking?

Someone explain it to me.

People come up to the pharmacy counter for advice. I'll spend time asking them questions, ascertaining the situation, determining with my best ability what is the best OTC medicine for their condition. I'm actually pretty good at it now. Most of the time people will take my recommendation, but then there's a lot of people... too many, really, that don't listen to a thing I just said and take something else (like some Homeopathic crap) off the shelf and walk off. Why did they waste my time?

Someone explain it to me.

Some people are on automatic refill. The computer calculates a date based on their last fill date and spits out a list a few days before when it should be due and we fill it. After a few months it gets way ahead and we have to reset the date, but sometimes a few prescriptions make it to the will call where people come in and bark about it and tell us they're "swimming" in that medication at home. The weird part is that SOME of these people have a zero co-pay on that med. IT IS NO COST TO THEM. Why wouldn't they just take it?

Someone explain it to me.

Tuesday, December 30, 2014

It's Next to the Unicorns

Some things don't exist.

But that doesn't stop people from asking for them. We get people that ask for things that do not exist. But don't try to tell them that. If you do, they get mad. No, the easiest thing to do is to send them to your competitor. Here's some things I've been asked for over the years:

Unscented Vicks Vapor Rub
Non-drowsy Benedryl
"Crackenspoil" cough drops (See this LINK)
Motrin (Without the Ibuprofen in it. See this LINK)
OTC antibiotics for the eye
OTC Crestor
OTC Viagra (we get this ALL the time)
Pseudoephedrine with the "sleepy stuff" in it
Banesin (See this LINK)
Tylenol without acetaminophen in it

So what do you do when someone comes in asking for something that's not OTC or doesn't really exist?

"I'm sorry. I don't see that we carry that. Maybe you should go to..."

They're on their way to you right now, Wagmart. Take good care of them...

Monday, December 29, 2014

My Advice: Be Careful with OTC Advice

An older fellow wanders up to the pharmacy counter.

"What do you have for my leg pain?" he asks. "I get pain in my legs at night."

After asking him a few questions, he tells me he refuses to see a doctor. Therefore the only advice I have for him is to try some Tylenol. I direct him to pain center area of the store.

A few minutes later he comes back with a tube of hydrocortisone cream and asks me if I think it will help his leg pain.

"No," I tell him. "Like I said, you should try some Tylenol."

He wanders off. After another few minutes he comes back with a can of Lotrimin spray and asks me if I think it will help his leg pain.

"No," I tell him. He wanders off.

Ten minutes later two women come up to the counter with him. I assume it is his daughter and wife. They start giving me the riot act as to why I would tell this man to get the cream and spray for his leg pain. They don't even give me a chance to respond before they turn around and storm off.

Given What's going on in Utah, now I'm certain I'm liable for a lawsuit.

Saturday, December 27, 2014

Blistering Miscommunication

"Where's that stuff you have for fever blisters?" he asked.

"We have Abreva. It's on aisle eight, on the left," I respond.

"No, that's not it. It's called Aleve, isn't it?" he says.

"No, it's called ABREVA," I say.

The guy shakes his head and wanders off in another direction away from aisle eight. I get busy helping another person and forget all about Mr. Cold Sore.

Thirty minutes later he's back. He shows me a package of Abreva.

"This is what I was looking for. By the way, it's on aisle eight over here."

I'm quiet. Is this a prank?

"And by the way," he adds, "That Aleve you told me about won't do nothing for fever blisters."

Thursday, December 25, 2014

Merry Christmas!

Merry Christmas and Happy Holidays
to all my readers, friends, and family!

Tuesday, December 23, 2014

Secret Lists and Secret Plans

I have a friend in another state. He works for Goofmart Pharmacy and is good friends with his former RPM. The RPM recently quit and told my friend some interesting things about their director.

I hope what I heard isn't true. And yet, I think it is probably spot on. What I'm about to tell you is unconfirmed, of course, but I wouldn't be surprised if it is the exact truth.

The RPM that quit felt compelled to do so because she wasn't getting along with the director. One of the things that bothered her was that each year in June the director asked the RPMs to rank the pharmacists in their area... based not only on metrics, but also on customer complaints and "write ups."

Now here's the bad part... the RPMs were asked to come up with an action plan to eliminate the BOTTOM THREE on their lists... to come up with a strategy to either get them fired or force them to quit. 

When she asked why they couldn't come up with an action plan to move them up the list, the director told her the bottom three weren't worth the trouble.

"We have plenty of graduating students we can hire to replace them," she was told.

If this really is true, it sucks. I've known some really bad pharmacists over the years, but to strategically plan to eliminate someone? These are people with families and house payments and responsibilities. I think that's just dirty and rotten. I've seen employees let go at other companies only as a last resort after being given every opportunity (and then some) to improve. This isn't like that. If true, this is horrible.

If you're a pharmacist... be vigilant. Watch your back. The Authorities in your area probably keep secret lists too. Keep your name OFF the list.

Monday, December 22, 2014

What is a GENERIC Drug?

A recent Twitter post by @PenguinCrystal in response to a blog post of mine stated "Generics aren't always equal," and that as a pharmacist, I should know that. See the original blog post HERE.

Basically my blog post recalls the story of a lady who brought back medication because it said "Endocet" on the label instead of "Oxycodone." The IRONY is that Endocet IS Oxycodone. Further irony occurs because in a lot of areas, the locals PREFER Endocet over the other generics. Finally, even more irony happens when I find out the patient is on Medicaid. Now I can't speak for all Medicaid patients, but the majority of mine are not overflowing in the IQ department, hence the blog post to begin with.

But as the tweet by @PenguinCrystal shows, there is a plethora of uneducated folks out there with a complete misunderstanding of generic medications. So just what is a generic medication? Below I have copied and pasted from the FDA website:

Generic Drugs: Questions and Answers

What are generic drugs?

A generic drug is identical -- or bioequivalent -- to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price. According to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. Even more billions are saved when hospitals use generics.

Are generic drugs as effective as brand-name drugs?

Yes. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken and the way it should be used.

FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs.

Not every brand-name drug has a generic drug. When new drugs are first made they have drug patents. Most drug patents are protected for 20 years. The patent, which protects the company that made the drug first, doesn't allow anyone else to make and sell the drug. When the patent expires, other drug companies can start selling a generic version of the drug. But, first, they must test the drug and the FDA must approve it.

Creating a drug costs lots of money. Since generic drug makers do not develop a drug from scratch, the costs to bring the drug to market are less; therefore, generic drugs are usually less expensive than brand-name drugs. But, generic drug makers must show that their product performs in the same way as the brand-name drug.

What standards do generic drugs have to meet?

Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. To gain FDA approval, a generic drug must:

> Contain the same active ingredients as the innovator drug(inactive ingredients may vary)
> Be identical in strength, dosage form, and route of administration
> Have the same use indications
> be bioequivalent
> Meet the same batch requirements for identity, strength, purity, and quality

> Be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products


Are there some generics out there that are not bioidentical to the name brand? Possibly. If this happens it usually shows up pretty quickly and is usually a manufacturing issue of some kind. Any time there is a question about any drug in the marketplace there is an immediate recall. But the vast majority of generic medications meet or exceed the standards of the brand/trade name.

Do companies actively make less potent medications to cut costs? In the United States or most first world countries, no. But if you're buying a generic from some shady mail order company or an Internet pharmacy based in India? Watch out. That's a different circus and a different monkey.

Millions upon millions of drugs are dispensed every day in thousands of pharmacies. The vast majority of medications have generics made by a multitude of companies. Suppose they really were all in collusion with each other to make less potent medications... the sheer manpower alone to create and maintain such a widespread conspiracy to cover up everything would cost more than the "profit" made from such a conspiracy.

Further suppose generic medications really don't meet the same equivalency as their brand/trade counterparts... then where is the outcry from the brand companies? Why isn't Lipitor suing the generic manufacturers? Or more likely, why aren't they running ads on TV stating "all generics of Lipitor are not equivalent"? The reason WHY you don't see these ads is because they don't have a legal leg to stand on.

So in conclusion, if you're a patient, feel safe using your generic medication and enjoy the money you saved. Yes, it's that simple.