Customer Savings Initiative

My place of employment has decided to implement a new "initiative". It technically involves us trying to convince people to switch their medications as they come in to the pharmacy. You heard right. We are supposed to tell people that they can save money by switching to a different but therapeutically similar generic drug. Would you like an example?

I'll use the example that Corporate gave us.

Mrs. Shelly Smith comes in with a script for Aciphex that she's been getting for 9 months.

Her brand co-pay is $30 and her generic co-pay is $10.

We are to suppose to stop her at drop-off and tell her that she can save money by switching to pantoprazole, lansoprazole, or omeprazole.

Now let's suppose she says no.

We're supposed to thank her for her consideration...fine.

But what if she says yes? Well then the shit hits the fan. First we have to set some shit up in the new computer system (which we don't have yet). Then we have to inform the patient that in order to fill their prescription, we have to contact the doctor for approval. Assuming the doctor approves this ridiculous decision, we get a verbal script over the phone and fill that new script. In a perfect world, this would take 20-30 minutes at the least. And that's if we get a hold of the MD himself/herself on the first ring when we call!

How about a dose of reality:

(I'll use drug names so as not to confuse)

Mrs. Smith says yes to us substituting omeprazole for her Aciphex (in order to save $20/month). Now our pharmacist has to stop what she is doing and call the doctor's office. Nine times out of ten, the MD is not available. They have to call us back, which means we have to tell the patient that they need to wait. Now what if you came in to a pharmacy expecting to wait 15 minutes for your prescription and now you learn that you are at the mercy of your doctor who, let's face it, doesn't care that you're at the pharmacy waiting for him to call. You've already left his office and he's made his money. He'll call the pharmacy when he gets a chance. Meanwhile, 10 minutes pass...20 minutes...30 minutes. Our pharmacist calls again to let the office know that you're still here waiting. The doctor calls back 10 minutes later and says that filling the prescription with omeprazole is OK. now you have to wait another 10-15 minutes while we type it up and fill it. All in all, you waited at least 45 minutes to get a generic drug that saves you $20. We're just getting to the good stuff.

Because we got authorization from your MD to fill a generic, your Aciphex Rx is now void in our system. I hope you like your new generic. But here you come 1 week later complaining about how omeprazole doesn't work at all and you want to return it and you want your Aciphex filled. Now we get the privilege of explaining to you that when you decided to go with omeprazole, your decision voided your Aciphex Rx. In order to fill the Aciphex, we have to call the doctor again and let him know that you don't like the omeprazole and you want Aciphex. The doctor then says to just fill the Aciphex then. Now we get to look stupid again and explain to your doctor that when he authorized a generic drug, it voided the Aciphex script. The doctor gives us a verbal Rx for Aciphex and now hates us (again this is after you wait another 30-45 minutes while we wait to hear back from the doctor). Now we have to tell you that once a prescription leaves the pharmacy we cannot take it back. You throw a fit because you're retarded and you don't have the patience of a normal human. You pay your normal $30 for your Aciphex and leave. Next month you transfer your script to some other pharmacy so you don't have to deal with this stupid shit again.

This is the dumbest idea anyone has ever come up with. I'm not even a pharmacist and I feel bad for my pharmacists. They're going to have to make 10 times as many phone calls. They're already stressed for time. They don't need this on top of what they're doing. We don't need this on top of what we're doing either. We are busy ringing people up and running to the damn drive-thru. We have to count prescriptions and meet budget everyday as well. We're already a busy pharmacy. It feels like Corporate is out of touch with the people who are actually having to do this retarded shit.

Brand vs. Generic

Pharmaceutical companies, such as Pfizer, AstraZeneca, Wyeth, etc. are businesses that invest in creating medications for our every day well-being. These can be blood pressure, cholesterol, antibiotics, analgesics (painkillers), or anti-psychotics. In order to create a new drug, the company must first develop a chemical. I'm going to use the drug Viagra as an example since everybody seems to know what that one's for. If you don't know, well, then you're retarded. Pfizer released Viagra in 1998. Pharmaceutical companies spend reported "millions and millions of dollars" on research and development in order to create a new drug. This money is also spent on tests and clinical trials.

Once a drug is developed by a drug company, they submit it to the Food and Drug Administration (FDA) for approval. After being approved, the drug receives a patent from the US Patent Office because technically, it is an invention. Drug patents can last between 2 and 17 years and is usually closer to the latter. During this time, the company spends more money on marketing and advertising in order to get the name of the drug out there to the public. This is when you see all the commercials on television.

Now, when you see the name of a brand name medication, you will see a big word underneath it usually in parentheses.

VIAGRA
(sildenafil citrate)

This word in parentheses is the chemical name of the drug--the active ingredient. Viagra's chemical name is sildenafil citrate. Just like all medication patents, Viagra's patent will expire. Its estimated expiration date is March 2012. When this date rolls around, a generic form of Viagra will become available. It will go by its chemical name of sildenafil citrate. Does this mean it's a totally different medicine? Quite the opposite. The name "Viagra" is a name that Pfizer came up with to call the drug. Even after the patent expires, the brand name drug will still be available.

Now let's look at cost. Why are brand name drugs more expensive and generics cheaper? As I mentioned before, pharmaceutical companies can spend a shit-ton of money on R&D for a single drug. After it is approved by the FDA, that company needs to start making its money back. How do they do that? Well, to begin with, drug representatives scoot around to doctors' offices dropping off information, samples, and stationary that is littered with the drug name. The doctor may or may not read about the new drug and decide it's worth prescribing. Now you have a prescription for a new drug. You take it to the pharmacy and with no insurance, you find out that your Viagra prescription is going to cost you about $150 for 10 pills. That's a real figure, too. Like I said, the drug company has to make their money back some way and in this case it's through the cost of the actual medication.

Let's fast forward to 2012. Viagra's patent has expired and "Company X" has decided to produce the generic form of Viagra. They will sell it to pharmacy wholesalers like Cardinal Health. Pharmacies that get their supplies from Cardinal Health will then order that drug. Now the pharmacy has the brand name and the generic form in stock. Our dilemma: which one do you choose and why?

As the FDA regulates all prescription and non-prescription drugs in the US market, it is their responsibility to ensure that the generic form of a drug be the same as a brand name drug in 7 categories. They are:

1) The generic form must be available in the same doses as the brand name. This means that since Viagra is available as a 25mg, 50mg, or 100mg tablet, the generic must come in those doses too.

2) The generic form must also be available in the same strengths. If Viagra contains 25mg of that active ingredient, sildenafil citrate, so, too must the generic.

3) The generic drug must be as safe as the brand name that was approved in the first place. If Viagra's main side effects are A, B, and C, sildenafil citrate's side effects cannot have a side effect of D.

4) The generic drug must be the same quality as the brand name drug. Just like the coke fiends who won't buy anything less than 60% pure, these drugs must match the brand name in quality.

5) The generic drug must work the same way as the brand name drug. If Viagra increases blood flow, so, too must sildenafil citrate. If Viagra is broken down and absorbed in the small intestine, the generic form must be absorbed into the body the same way. This is critical.

6) The way the drug is taken is also something the FDA looks for when approving a generic drug. If Viagra is only available as an oral tablet (which it is), then the generic must be taken that way as well.

7) Lastly, the generic drug must match the brand name drug in the way it is used. If viagra should be taken with food, so should the generic. If it needs to be taken 30 minutes to 4 hours prior to sexual activity, so should the generic.

Number 5 is known as bioequivalency. The definition of bioequivalency according toDictionary.com is "the condition in which different formulations of the same drug or chemical are equally absorbed when taken into the body." So, when someone tells you that the generic drug doesn't work the same, 99.99% of the time, it's all in their head. By FEDERAL LAW, it has to work the same.

I mentioned before that the chemical name is known as the active ingredient. If this is so, then what is/are the inactive ingredient(s)? Inactive ingredients are what make up the color, the shape, the size, etc. of the tablet or capsule. 99.99% of the time, these have absolutely no affect in the difference between generic and brand name drugs. These don't need to and don't have to be the same. The generic drug actuallyhas to look different or it infringes on copyright and patent laws. I can't make the same red fire truck you did and call it something else if it has your company name on it--mine has to look different somehow.

I have already mentioned cost. Since these generic pharmaceutical companies don't need to spend money on R&D, they can sell their product for less. The research and development has already been done by the brand name company. When the patent expires, this information becomes public knowledge.

What about those $4 and $10 programs?

The $4/$10 program is available at Wal-Mart, Target, Kroger, Giant Eagle, and Meijer. These big stores can afford to do this because they make money on other sales in their stores. When they give you a prescription for $4, they do not, I repeat, DO NOT bill your insurance company. They just set it to the $4 or $10 price and give it to you. CVS and Walgreen's cannot afford to do this because the majority of their business comes from prescription sales and the do not make up sales in the front store. This is a good idea for people with no insurance. If you don't have insurance, go to one of the $4 program stores and see how cheap it is. If you have insurance, it won't make a difference unless you tell the bigger store not to bill your insurance.

Let's recap:

1) Generic drugs are, BY LAW, the same as brand name drugs. They work the same!

2) Generic drugs cost less because the generic drug manufacturer doesn't need to make their millions and millions of dollars back due to R&D.

3) If you don't have insurance, go to a big store and leave us at CVS, alone.

So why get brand name drugs? See? You don't even have a reason. Most of the time, pharmacies dispense generics by default anyway.

Just get the generic...

I'd like to thank Adam M. for sharing this with me. It was a message he sent me:

It IS a giant myth that drug companies need to maintain their hold on the market. Do you wonder why al this r and d never leads to any great new cures. It is because the drug co. know the best way to profit is to grab a share of something already making a ton of money. That is why you have nexium, prevacid, protonix-they were developed to grab a share of old prilosecs earnings. Crestor the same with lipitor. Cholesterol, diabetes, ppis. Just a few different categories but all these variations. Nothing pioneering or revolutionary. At 1:05 lok at the chart. That chart is based on the companies listed on the bottom own figures. THEIR OWN figures they submit for analysis. Look at it: R and D is half of what they spend on marketing... This information is out there, the companies themselves don't hide it, but peope believe the same old myth.

http://www.youtube.com/watch?v=kWLQpnRlt5A

Underappreciated

Why is it that so many people take their pharmacy and pharmacy staff for granted? Just because we have a damn drive through doesn't make us a fast food restaurant! Don't come through our drive through and hand us 5 prescriptions and tell us you want them "now". And don't think that you're getting away with 6 different scripts from 6 different doctors all for 20 or 30 Percocet. We know what you're doing. It makes it worse when you limp in, moaning about how you're back hurts. If it was really hurt, you'd go to a specialist--not 6 ER docs in one month's time. You're not fooling anyone. Unfortunately, you're scripts are legit so we have to fill them. You're taking advantage of the doctors (although they are stupid for prescribing that shit to you) and us. It's un-fucking-believable that you can get away with this.

To all you motherfuckers cheating on Caresource/Molina (now Medicaid): Go Fuck Yourselves.

Why should my tax dollars pay for your birth control when you pull up in a Lexus and with a brand new Blackberry? What the fuck is that?! You're lucky I don't jump through that goddamned drive through window and ring your neck. I also refuse to pay for your medication just because you don't want to get a job. Being lazy shouldn't make you qualified for Medicaid. However, in Ohio, for some reason it does. I'd like to "audit" every person who comes through our pharmacy on Medicaid and see if they really need it. What percentage of Medicaid patients really need it?

Ugh...I just needed to vent.

That's Not How It Works

It's not as easy as it seems. Things take time, processes need approvals, etc. Nothing is instantaneous.

When it comes to working in a pharmacy, time is an important factor. Prescriptions need to be filled quickly and accurately in order for the company to turn a profit and keep customers happy.

These are a few situations where the only appropriate response from the pharmacy is, "That's not how it works".

Patient (coming through the drive-thru and handing me an empty prescription vial): "Yeah I need a refill."
Me: "Well, you see here where it says 'Refills require authorization'? That means you're out of refills."
Patient: "No my doctor gave me a year's worth of refills."
Me: (after looking it up on the computer): "Yes, he did. 12 months ago. You need a new prescription."

Now, this could go one of two ways. Let's see what happens.

Patient: "Oh, ok. Thank you!" (and drives away)

That is the perfect response from the customer. This customer is apparently responsible enough to call his own doctor and request his own new prescription. He is what we refer to as "smart". But what about the other possible outcome of the situation? Let's take a gander.

"...You need a new prescription."
Patient: "Well, can't you call my doctor?"
Me: "Yes, we can send him a fax."
Patient: "And you'll call me when it's ready?"
Me: "Well, if you want to check back with us maybe tomorrow afternoon and see if we've heard anything by then we may have an answer for you. We make and receive dozens of phone calls all day long."
Patient: "Ugh, fine."

In this particular situation, the patient chose to be what we refer to as a "total and utter douchebag". Look, be responsible for your own shit. Call your own doctor. Keep track of your own refills. It's all on your prescription labels no matter what pharmacy you go to. If you see that you have 1 refill remaining, call your doctor! The pharmacy is responsible for filling and refilling your current ACTIVE prescriptions. Although we do it, we should not have to remind you to fill a prescription or contact your doctor or tell you the directions because you don't want to read.

These last situations are for the people who work in a pharmacy and can relate.

Customer: Yeah uh, my doctor only wrote this Vicodin script for 20 but it's supposed to be for 80. Can you call him?

Customer: Yeah I need a refill.
Me: On which medication?
Customer: Um, I can't pronounce it, ox-oxy-oxycodin-oxycodeine?

Customer: Can I get a refill?
Me: On which medication?
Customer: My Vicodin.
Me: Well you just filled a 30-day supply 2 weeks ago.
Customer: Yeah, uh, I'm going to Mexico.

Me: You have one to drop off?
Customer: Yeah I have 4.
Me: When did you want to pick them up?
Customer: ...Now.