Drug Topics Voices 01-15-2014

He called it

Re: “Hold the Phone” [David Stanley, View from the Zoo, November 2013]:

Three cheers to David Stanley for calling it as it really is in the real world.

It seems that all of corporate management has resolved to follow the industry “leaders” in their pursuit of cost containment by somehow getting paid for MTM and by getting a machine to answer the phone.

In spite of their inability to get a fair margin of profit on the product, they want us to manage a patient’s therapy  while the medication may or may not be dispensed correctly by another pharmacy. And they think that insurers will not cut the reimbursement of that service in the future?

It is a fact that the analysis and proper dispensing of a prescription will continue to be a prerequisite of the management of the therapy. That still takes time, and a
machine 1,000 miles away may not get it right. And the storage requirements of meds will never be satisfied by delivery to a mailbox.

Eugene P. Harvey, BS, RPh

Ellenton, Fla.

The phone is only the beginning

Thanks to David Stanley for his insightful column “Hold the Phone.”

When pharmacy resembled Sen. Robert Dole’s description of the U.S. Senate (“a good job; inside work, no heavy lifting”), it was the dream profession.

Nowadays, however, to an objective observer passing by the well-lit department in a variety of big-box and grocery stores, the pharmacist appears to:

• Stare, eyes glazed, at a pixelated screen of lifeless data such as group and bin numbers, cardholder and issuer ID, and interaction overrides;

• Have a permanent ear-to-ear frown  attached to a surgically implanted headphone;

• Need three breaks: one to urinate, one for lunch, and one to vacation somewhere, anywhere, inane or insane;

• Be two alprazolam and one SSRI away from suicide.

The darkened nighttime prescription departments are often caged in impenetrable steel accordions. Is this to discourage Vicodin thievery, or are the pharmacists inside being held hostage, hiding, a short nap away from the next shift?

Charles Spiher, RPh

Patagonia, Ariz.

When will they learn?

Re: David Stanley’s December column [“How do you hold two positions at once? Ask FDA”]:

Once again bureaucrats have made changes in the controlled drug schedule, and all it will end up doing is becoming another “feel-good law” without making any substantive change in the number of people who are abusing some substance.

In some areas of the country we have already seen how bureaucrats have “tightened down” on the diversion of legal prescription items to the street, only to find that those who abuse will shift to another substance, typically heroin, cocaine, crack, or marijuana - all Schedule I substances and illegal - whose use/abuse is growing at a geometric rate.

As a society, we ignore the 20%-25% of the population addicted to nicotine, as well as the estimated 20% who are borderline alcoholics, and instead we focus on the 5% of the population who desire to abuse substances derived from the poppy plant. Why does our society turn a blind eye to certain addictions, yet obsess about eradicating others?

We have been fighting “drug abuse” since the enactment of the Harrison Narcotic Act of 1914; you would think that some would come to the intelligent conclusion that we are like a dog chasing its tail: getting nowhere quickly!

Steve Ariens, PD

Louisville, Ky.

Really. Just give them the chair

I just finished reading Goose Rawlings’ column “C’mon, folks, give them the chair!” [In My View, November 2013]. Everything he said has been espoused by me ad nauseum.

I am one of those pharmacists who has done a lot in his career. I was a corporate VP, a multi-store owner, and a district manager. I have seen all sides.

I hope I never committed any of the sins mentioned in Goose’s column. I particularly liked his expression “a partnership of meanness,” although I tend to believe these circumstances arose more out of
ignorance than meanness.

As he stated and as I can attest through experience, many of the chain-store executives are pharmacists who never worked the bench. Although I’m sure some of my former subordinates would find fault
with me, none could deny that I always looked the other way when I saw a stool. Not to allow one is inhumane, and there is no good reason for it.

Stu Schwartz, RPh

Monroe Twp., N.J.

A modest proposal

Re: Robert Mabee’s December article [“The political-medical complex,” DT Blog]:

The U.S. healthcare system needs one simple fix: a citizen-based allocation of resources, rather than a big government central planning allocation of resources.

Our politicians and government agencies have created a lumbering, red-tape-laden healthcare monstrosity, with bureaucrats, analysts, programmers, regulators, monitors, enforcers, healthcare coaches, and NFL advertisers all
involved in the administrative chain. None of that has anything to do with patients and point of care: timely access to preferred physicians, pharmacists, and other primary care providers.

We need to refocus on the patient-provider relationship. We need to
decentralize and return to a citizen-based allocation of resources for our basic, everyday healthcare needs. This action would involve directing the Federal Reserve, through a “Citizens Credit Facility” (CCF), to electronically deposit $20,000 into the Medical Savings Account (MSA) of every U.S. citizen who wishes to participate.

Then amend the individual mandate to bring the private insurers back onto the playing field by allowing families to purchase high-deductible major medical policies with precisely the types of coverage that fit their needs and desires.

For a period of five years, participating U.S. citizens concurrently enrolled in Medicare, Medicaid, VA, Tricare, and FEHB (approximately 121 million people) would each pay a $4,000 annual deductible (a total of $484 billion - completely covered by MSA funds).

This “Citizens Plan” would have a vast cleansing effect. It would cut out massive and burdensome administrative costs and restore individual freedom to choose one’s own providers and services. And all citizens would have the resources they need for basic day-to-day healthcare needs.

Doors are closing fast in the healthcare field. We need a rescue plan. Cash paying customers would keep those doors open.America needs that.

Bernie D. Hendricks, RPh

Brookings, S.D.

That explains that

Re: Your article “TRICARE’s mail-order program earns high marks in federal audit” [Up Front, October 2013]:

Obviously TRICARE got all of its
information from ESI. OIG needs to report where it got info - I am sure it wasn’t from a local pharmacy. PBM greed leads to endless lies and propaganda!

On the same page you reported some actual facts, that 84% of seniors don’t want mail-order. The answer to the question that never gets asked -”What’s best for the patient?” - will always be a face-to-face encounter with a pharmacist providing medications, never mail-order.

Kevin Currans, PharmD

Sleepy eye, Minn.

Seen on the web

Mark Lowery's story “Pharmacist wins age discrimination case against CVS” [November 21, 2013] drew comments from many readers. A sampling follows.

"I personally know over 20 pharmacists terminated by CVS in the last three years, all of them over 45. It must be in the business plan to eliminate older pharmacists for younger, lower-paid staffing, now that a glut exists. I suggest that all pharmacists who feel they were wronged by CVS contact the attorney in the article for help."

Karl Deigert

"CVS calls them “legacy” pharmacists, then tosses them out."

Anonymous

"It happened to many in South Florida. I was terminated at 65 after getting a new district manager and commendations for the previous year’s work.

"It was the best thing that happened to me. Went back to work at a private pharmacy that caters to elderly patients, where the pharmacist does pharmacist’s work. We do many more prescriptions than CVS on the other side of the street."

Herbert Stupak

"I worked for Revco and then for CVS after the merger. You will never see a company treat its help as Revco did. It respected us as professionals, as CVS did after that.

"I retired in 1997 and worked part-time for CVS till 2003. My age at retirement was 70. CVS treated me fairly, but that was when pharmacists were in short supply.

"Times have changed, and I’ve noticed that many of the older pharmacists at CVS are no longer around, replaced by new graduates. Supply and demand play their role. You will find this happening in other places as well. It may not be fair, but that is the way things progress."

Anonymous