Pharmacy Edge Issue 2 2016

PHARMACY EDGE

MAGAZINE ISSUE

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PHARMACY EDGE MARCH We hope you will find this online magazine useful and informative!

Read our Presidents message inside.

REVAMP TO MEDICARE PART B SOMETHING MAGICAL ABOUT MONDAY You’ve known this for years and have just come to accept it.

MAR/2016

Table of Contents Issue 2 / March, 2016

Presidents Message Achieving Financial Independence

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CMS Proposes Revamp to Medicare Part B Drug Reimbursement

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Infinitrak To Participate In Fda Dscsa Workshop

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Senate Works to Address Opioid Epidemic

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United Rx solutions now open for business

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There’s something magical about Monday.

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PRESIDENT’S MESSAGE We want our association to embody all that this country represents; Integrity, Strength, and Honor.

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t’s been said, “imitation is a form of flattery”... So perhaps we at the APPA should be blushing. When we chose the name American Pharmacy Purchasing Alliance, we did so in honoring this great nation. We want our association to embody all that this country represents; Integrity, Strength, and Honoring the hard work and dedication that has made this nation the greatest nation on earth.

Recently, we were made aware of a new entrant into this “arena” of pharmacy groups or alliance(s). We understand the need for free enterprise and the benefit of competition. We have worked hard in bringing to you an association that is for the common good of the industry. Perhaps that association will push us to be better.

We look forward to see what they offer and we wish them well.

However, we have our doubts as to how truly “independent” they will be and how the pharmacy community will benefit. After all, if a retail pharmacy group is behind the alliance, one has to wonder what is the value that they will bring to the true independent pharmacy owner. As many of you know and it pains me to say, we had to cancel PharmaCon Expo, due to a conflict in scheduling at the venue. What many of you don’t know, is that while we were putting this together, a former board member was taking the lead in finding the Keynote Speakers. As those individuals became known to us, it became clear that this person had a self-serving agenda. As this occurred, I pulled back from discussions that were being had to form a closer business relationship. I did not want to expose the APPA to an appearance of favoritism or worse. In establishing the advisory board, I looked to fill it with various groups to avoid any pharmacy owner or pharmaceutical group from having a self-serving interest or role.

As you read through this, I hope you understand that it is not being written with malice or with the intent to hurt another business. It is being written so that everyone can be clear, that even in the close knit pharmaceutical community, people are not always interested in your well being. Additionally, since I had private confidential talks with the former board member as to the direction of the APPA, I am having my legal team review any conflict of interest that might exist, from this newly formed alliance (via a former board member).

The state of our industry remains strong. I am proud to be a part of such a great family. In the near future, we will be electing a new President of the United States. With that, there promises to be changes made to the health care industry. Count on the APPA to bring you updates to changes that will impact our industry.

Stay tuned.... our 3rd issue will bring some exciting news to events we have planned.

I humbly thank you for all of your support we have received in the past months. Additionally, I thank you in advanced for your continued support in the future. We at the APPA have always been open, I welcome your feed back and opinions on how we can continue to move forward.

Respectfully yours, Joshua Pirestani President

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ACHIEVING FINANCIAL INDEPENDENCE …DO YOU KNOW YOUR NUMBER? By: Timothy R. Ulbrich, Pharm.D., R.Ph www.yourfinancialpharmacist.com

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or the purpose of this article, let’s define financial independence as “the point at which one is able to make the choice as to whether or not he/she will continue to work while having great confidence that savings accrued will last until his/her death.” A little bit exciting and a bit morbid at the same time, right?

I’m specifically using the term financial independence rather than retirement. To me, trying to retire implies that someone is seeking to reach the point at which they do not have to work anymore. I have heard too many people discuss working towards retirement in a way that gives me a visual of someone limping to the finish line. I don’t know about you, but I don’t want to limp to the finish line. On the other hand, financial independence implies just that; independence. This is the point at which one may choose whether or not to continue working, but he/she financially is in a position to make that choice. Now that sounds exciting!

In order to calculate the ‘magic number’ at which you will reach financial independence, you need to start by answering two very important questions. First, what is your life expectancy? Second, what is the desired age at which you would like to be in a position to choose whether or not you are working? Again, this doesn’t mean you necessarily will stop working at this age. Rather, you will be in a position to make that choice.

While other variables can play a significant factor in this equation (e.g., amount saved per month, assumed rate of return on investments, etc.) I am encouraging you to start with these two variables since the first (life expectancy) plays a very important role in knowing how many years of savings you have to account for and the other (the age at which we want to have a choice as to whether or not we need to work anymore) is part of the dream. So go ahead and write these down. First, determine your projected life expectancy based on your gender and date of birth. You can look this up at https://www.ssa.gov/OACT/population/longevity.html. After you get past the number of years the government projects you have left to live (it took me a while!), write down your desired age at which you can make a choice as to whether or not you want to work anymore. This is the fun part. Dream a little bit here and if your calculations come back as requiring a plan that may not be realistic, you can adjust later.

So what other variables do you need to account for to determine the point at which you may reach ‘financial independence’? These include the following:

»»Percentage of working income needed to live each year after your desired age of reaching financial independence »»Rate of return on your investments »»Salary increases throughout your working career »»Rate of inflation »»Whether or not you expect to receive social security benefits Let’s walk through one example together and then you can do the same on your own.

Let’s assume we have a 40-year-old male pharmacist, Jonny, who has $500,000 saved to date. According to the Social Security Administration web site, Jonny has a life expectancy of 82 years. He has a desire to reach financial independence at the age of 65. Therefore, we know that he has 25 years left to work and can expect to life 17 years beyond his desired age of reaching financial independence.

The next important variable you need to determine is the percentage of income during the working years that you want to have available if you were no longer working. 80%? 100%? 120%? Often you will hear that a lower percentage of your income (such as 80%) is reasonable to have during this time period with the assumption that 4

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expenses will be higher during one’s working career. For example, the goal would be to have a paid off home without any monthly mortgage payment like is often being made during the working years. The counter to this argument could be for someone that desires to have significant expenses during this phase of life (e.g., travel, buying a second home, etc.) or would like to be in a position to give away money at a rate they weren’t able to do during the working years. For Jonny’s example, let’s go forward assuming he wants to have 100% of his current income (adjusted for inflation) available to him when he reaches the age of 65 in case he decides he no longer wants to work at that point.

Next, what rate of return can you expect to earn on your investments? While some of this is out of our control based on the volatility that comes along with investing, a projection can be made based on how conservative (assumed lower %) or how aggressive (assumed higher %) you may be in your investment approach. In addition, the assumed rate of return can be significantly impacted by the fees incurred based on the choices you with your investments (e.g., advisor fees, fund fees). (Note: If you are not comfortable with selecting a diversified investment plan that matches your risk tolerance, please seek help from a financial advisor.)

For the assumptions for Jonny, let’s make it simple by choosing an average rate of return of 6% during his working years. This portfolio includes a mixture of stocks and bonds invested in various mutual funds. When he turns 65, let’s assume he moves his investments around into a portfolio that is more conservative earning approximately 3% growth per year.

The last three variables we need to consider is projected salary increases throughout your working career, rate of inflation and whether or not you will have social security benefits paid out to you upon retirement. For our example, let’s be conservative and assume Jonny receives 3% annual salary increases throughout his career that match a 3% annual inflation rate. Last, let’s assume he will not plan on receiving any social security benefits.

If we use a nest egg calculator such as the one at Bankrate, we can use the aforementioned variables to determine how much money he should have at the age of 65 to last until his death if he chooses not to work beyond that point. Here is how it would pan out for Jonny: pharmacy edge

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Holy cow! Jonny needs to save $3,727 per month to reach this goal! I don’t know about you, but that seems like a lot of money. Now, if he were to have a solid employer retirement plan with a good employer match, that might lessen that blow to some degree.

Remember, this was a fairly conservative calculation that assumed Jonny’s raises throughout the remaining 25 years he is planning to work would not outpace inflation. Also, remember, we assumed he would need 100% of his adjustedinflation income at the age of 65 (likely assuming he never works again). And last, we assumed he would receive no social security benefits. On the flip side, Jonny could live much longer than 82 and therefore need much more in savings.

CURRENT AGE

40

SALARY

$120,9501

CURRENT SAVINGS

$500,000

DESIRED AGE TO REACH FINANCIAL INDEPENDENCE

65

YEARS OF INCOME NEEDED PAST THE AGE OF DESIRED FINANCIAL INDEPENDENCE (BASED ON LIFE EXPECTANCY OF 82)

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EXPECTED INCOME INCREASE (PER YEAR)

3%

PROJECTED RATE OF INFLATION (PER YEAR)

3%

PERCENTAGE OF CURRENT INCOME (IN FUTURE DOLLARS) NEEDED AT THE DESIRED AGE OF REACHING FINANCIAL INDEPENDENCE

100%

RATE OF RETURN ON INVESTMENTS DURING THE WORKING YEARS

6%

RATE OF RETURN ON INVESTMENTS AFTER THE DESIRED AGE OF REACHING FINANCIAL INDEPENDENCE

3%

Social Security benefits

No

Amount Jonny needs saved at the age of 65 (‘nest-egg’) $4.3 million So how would this look differently if we changed a few variables? As one example, if we change Amount needed to save each month to reach the goal $3,727 the desired age to reach financial independence 1 Median salary of a pharmacist (Bureau of Labor Statistics, 2014) to 68 while leaving all other variables constant, Jonny would then ‘only’ need to save $1,964 per month to reach a total nest egg of $3.9 million. That is a big difference ($1,763 per month to be exact). Or, if we change the assumption where he would need 80% after reaching 65 (instead of 100%) and keep all other variables constant, he would need to save $2,317 per month to achieve a total nest egg of $3.4 million.

Again, there are lots of assumptions (besides those I mentioned) that can have a significant impact on this equation. For example, fees on your investments and/or advisor fees can be a significant component when you consider the impact over 30+ years of savings. Another would be how much of your savings are in a vehicle that will require you to pay taxes upon withdrawal (e.g., 401k) versus those where taxes have already been paid and your growth will be withdrawn tax free (e.g., Roth IRA). Obviously, if one has significant savings in a vehicle such as a Roth IRA, the amount he/she requires during retirement will be less since those dollars will go farther. And last, if you are lucky enough to be in a work environment that still offers a pension of some sorts, that of course would change the equation by providing some guarantied income in retirement and therefore lessening the amount you need to save now.

So, does this excite you or depress you? Personally, I’m a fan for knowing what the goal is and being aware of what it takes on a day-to-day (or month to month) basis to make that goal a reality. We might not like the answer the calculator gives us in terms of how much we should be saving on a monthly basis. However, this gives us a starting point to make adjustments to different variables (e.g., desired age for reaching financial independence, approach to investing, etc.) that can result in a plan that is realistic. Isn’t that better than hoping we someday reach retirement?

Let’s keep the conversation going. Please visit www. yourfinancialpharmacist.com to sign up for my blog designed to empower pharmacists and pharmacy students to achieve financial freedom. Also, you can connect with me further on Twitter (@FinancialRPh) or via Facebook (www.facebook.com/yourfinancialpharmacist).

Let’s all learn together.

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CMS PROPOSES REVAMP TO MEDICARE PART B DRUG REIMBURSEMENT IN TWO PHASES PRACTICE AREA / INDUSTRY: HEALTHCARE

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he Centers for Medicare and Medicaid Services (“CMS”) announced a proposed rule (CMS-1670-P) to test new models to improve how Medicare Part B pays for prescription drugs. Medicare Part B covers drugs that are administered in a physician’s office or hospital outpatient facilities such as chemotherapy medications, injectables like antibiotics, or eye care treatments such as Lucentis®, a drug commonly used by retina specialists.

According to CMS, the proposed rule is designed to test physician and patient incentives to do two things; drive the prescribing of the most effective drugs, and test new payment approaches to reward positive patient outcomes. The proposal involves reducing the percent of add-on to the Average Sales Price (“ASP”) of the drugs from 6% to 2.5% plus a flat fee of $16.80. CMS suggests that the current 6% add-on to the ASP encourages the use of higher priced drugs versus inexpensive drugs where the higher cost does not improve outcomes.

By lowering the ASP add-on to 2.5% plus a flat fee, CMS is looking to discourage the use of expensive drugs where less expensive drugs produce comparable outcomes.

The second of the proposed changes would utilize

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the value-based purchasing tools now used by private health plans, pharmacy benefit managers, hospitals and other entities that manage health benefits and drug utilization. CMS reviewed numerous value-based purchasing tools and identified those that may be applicable to payment for Part B drugs with the same positive results.

These tests would begin no sooner than January 1, 2017 and the pricing strategies would include: Discounting or eliminating patient cost-sharing;

»»Feedback on prescribing patterns and online decision support tools to de-

termine best practices based on a clinician’s prescribing patterns relative to geographic and national trends; Indications-based pricing to test the payment for a drug based on its clinical effectiveness for different indications; Reference pricing for groups of similar drug products; and Risk-sharing agreements with drug manufacturers based on outcomes.

»» »» »»

If finalized, the proposed model would run for five years with the new pricing frameworks active in the last three years. While all healthcare providers in Medicare Part B would be required to participate, not all would be subject to the test—CMS would place providers in control or study groups based on zip code.

“These models would test how to improve Medicare beneficiaries’ care by aligning incentives to reward value and the most successful patient outcomes,” said Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality & CMS Chief Medical Officer. “The choice of medications for beneficiaries should be driven by the best available evidence, the unique needs of the patient, and what best promotes high quality care.”

The American Society of Clinical Oncology (“ASCO”) along with several cancer organizations and the pharmaceutical industry have publicly reacted negatively to the CMS proposed rule. A coalition of more than 100 trade groups sent a letter to CMS detailing their opposition and asking for the rule to be withdrawn. In reporting by Medscape Medical News, Allen S. Lichter, M.D., CEO of ASCO, said that it is “inappropriate for CMS to manipulate choice of treatment for cancer patients using heavy-handed reimbursement techniques.” He added that physicians “did not create the problem of drug pricing, and its solution should not be on their back.”

The proposed rule is published today in the Federal Register and will be open for comments for 60 days, through May 9, 2016. To view the proposed rule, click here.

For further information on the subject matter of this alert, please contact the following FisherBroyles attorneys: Brian E. Dickerson brian.dickerson@fisherbroyles.com 202.570.0248 Nicole Hughes Waid nicole.waid@fisherbroyles.com 202.906.9572 Anthony J. Calamunci anthony.calamunci@fisherbroyles.com 419.376.1776

__________

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As a the leading provider of software solution that offers for pharmacies dispensers InfiniTrak enables our customers to be a fully compliant with the evolving DSCSA solution law. InfiniTrak has been at the forefront of ensuring that the needs of independent pharmacies have an affordable tool that is also effective in the fight against counterfeit and diverted drugs.

InfiniTrak’s Chief Compliance Officer, Denise Garcia noted that “our focus on the independent pharmacy community began early – when there was first talk about new track and trace regulations. There is no question that it is an extremely complicated problem and that new regulations are required. However, we want to make sure these regulations are workable for the independents, and that their voice in this is heard. We are very glad to be at the FDA table.”

InfiniTrak will participate in the upcoming FDA Drug Supply Chain Security Act (DSCSA) Pilot Project workshop, which is expected to focus primarily on clarifying objectives of pilot programs for serialization and serialization data exchange. The event will be the first in the agency’s required series of public meetings to gather stakeholder requirements and explore approaches for DSCSA implementation.

The FDA announced the workshop last month, billing it as a “forum for discussing proposed design objectives of pilot projects that will explore and evaluate methods to enhance the safety and security of the pharmaceutical distribution supply chain.” InfiniTrak will attend this event with many of our customers along with other key stakeholders we work alongside in the join other pharmaceutical distribution supply chain. InfiniTrak looks forward to members at contributing critical feedback gathered by our customers and adding value to the forum to by discussing the future of the implementation of the DSCSA such as issues related to utilizing the product identifier for product tracing, improving the technical capabilities of the supply chain, and identifying the system attributes that are necessary to implement the requirements established under the DSCSA while allowing our customers to keep their organization operating without disruption.

The public workshop will be held on: April 5, 2016 - 9 a.m. to 5 p.m. and April 6, 2016 - 9 a.m. to 12:15 p.m.

Silver Spring, MD at the FDA’s White Oak Campus.

Input at the workshop, along with public comments that can be submitted, will help direct the FDA’s development of its pilot project program.

INFINITRAK TO PARTICIPATE IN FDA DSCSA WORKSHOP Forum Provides Opportunity for Input on DSCSA Objectives and Implementation

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We are waiting for additional information on a live webcast, details on which will be available by the end of the month at http://www.fda.gov/Drugs/NewsEvents/ucm481767.htm. The Webcast will be conducted in listening-mode only.

Please stay tuned for more information on the workshop agenda, and any other relevant information in the days to come. We As an added service to our customers we will be are arranging a system to solicit collect questions from you and your membership so that your interests can be fully represented at the workshop. __________

GET THE FACTS: DSCSA POCKET GUIDE As a valued member of APPA you can receive a complimentary copy of the latest DSCSA pocket guide, compliments of InfiniTrak.

Available in electronic or print format, get the facts on the Drug Supply Chain Security Act (DSCSA) and information about your compliance solution, InfiniTrak.

The DSCSA is a new law that is being implemented by the FDA and will be ongoing for the next 5 years. This valuable resource is the first step in understanding the regulations and enabling your organization to be compliant.

We hope you find the pocket guide serves you well and that you take full advantage of InfiniTrak today!

Register online at www.infinitrak.us

SENATE WORKS TO ADDRESS OPIOID EPIDEMIC, IMPLICATIONS FOR PHARMACY FIELD

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he political battle to address opioid

addiction continues. Thus far efforts have enjoyed surprising bi partisan support in the Senate, but the Comprehensive Addiction and Recovery Act, known as CARA, still has a long road to travel.

CARA will attempt to address the opioid epidemic by enlarging prevention and education, and promoting resources for treatment and recovery. It involves reforms to assist law enforcement, respond to the drug epidemic, and supports long-term recovery programs. The legislation also enlarges the accessibility of naloxone, a lifesaving drug that helps to reverse overdoses, and creates disposal sites for unwanted prescriptions.

Essential to many advocates, CARA also delivers funds for treatment alternatives to

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incarceration. Articles have shown that state and counties with drug courts have reported cost savings and decreased recidivism rates among graduates. As proposed, the legislation also provides a provision to develop treatment programs for pregnant women and mothers who have a substance abuse.

Medicare Pharmacy & Prescriber “Lock In” Amendment passes

The Senate recently accepted an amendment to CARA that provides Medicare Part D plans the power to require at-risk beneficiaries to use a single prescriber and pharmacy for regularly abused drugs.

It is identified as the “lock-in” provision, and is sponsored by Tim Kaine (D-VA) and Ohio Senators Rob Portman (R-OH) Pat Toomey (R-PA) and Sherrod Brown (D-OH) demonstrating the cooperation across the aisle this issue is getting. This amendment is aimed at addressing that many patients with addiction problem have numerous prescriptions they are filling and the concern that many people who overdose on opiates often end up back on those same drugs in little to no time.

The American Pharmacist Association (APhA) supported the passing of the lock-in amendment and says it feels that solutions to stop prescription and opioid drug abuse will take patients, health care professionals, state, local and federal governments working together.

Though the lock-in amendment has been approved, the Senate still has to vote on the wider Comprehensive Addiction and Recovery Act before it moves to the U.S. House of Representatives for evaluation.

There is a question whether the bi partisan cooperation will continue at that point.

The opiate issue was one of the concerns that slowed the confirmation of the new head of the FDA. Senator Markey halted the nomination asking that the current opioid approval procedure be appraised

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by an FDA review panel and feels they should incorporate the danger of drug abuse and addiction into the process. He also desired the agency to withdraw their August 2015 approval of OxyContin for children and develop an advisory panel to aid in the process. After the FDA promised to make the opioid crisis “a top priority” Markey removed his hold and Califf’s nomination was approved.

Opiate addiction issues grabbed headlines when a rising death rate for middle aged white Americans was reported at the end of 2015. As Med Career News reported, drug overdoses were seen as a major contributor to the national problem. According to the CDC, U.S. drug overdose deaths were at an all-time high in 2014, rising to 6.5 % to 47,055, led by heroin abuse and prescription painkillers. Since 2000 the CDC stated that deaths from extremely addictive opioids have increased 200%, in addition, people addicted to prescription painkillers are increasingly turning to widely available, often less expensive, heroin.

MedCareerNews provides information about the medical field that will affect your career options, advice about moving your career forward, quizzes and more! Subscribe on the website today or follow Med Career News on Facebook, Twitter, Linked In, Pinterest or Google Plus. We also provide medical career targeted help with your cover letter, resume and sales plans in our Products section.

Lindsey McCoy MPA, is an Executive Medical Recruiter, co founder of Med Career News and former CEO in the not for profit sector. __________

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UNITED RX SOLUTIONS NOW OPEN FOR BUSINESS Building Relashionships Through Honesty And Integrity.

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hey started out many years ago as young adults in this industry. When the industry itself was still young. Back when potentially new and unaware customers still excitedly replied, “I can get money back for that stuff?” But now the partners and owners of United Rx Solutions are back and they are on a mission.

This month of March marks the grand opening of United Rx Solutions, a new pharmaceutical reverse distributor. The core of their business involves helping independent community and hospital pharmacies properly handle their expired medication returns. But the four partners, David Silvis, Christopher Louis, Van Schuette and Robert Dooley want to go way beyond “just handling returns.”

The four partners that own United Rx Solutions possess over 90 years of combined industry experience. They have serviced pharmacies, coordinated warehouse operations, and most likely trained some of your favorite reps. As accomplished veterans, the owners are quite aware of what is lacking in the industry.

“In speaking with our potential clients and drawing on our own experiences, we know there is, in some cases, a lack of good quality service, transparency and accountability,” said Robert Dooley. “It is quite obvious that things must change. Where there is confusion, there is an opportunity to take advantage of people. We want to use our platform to make sure our clients are informed and armed to protect themselves.”

United Rx Solutions wants their clients to be well educated about the whole entire returns process - something that still remains a mystery to many. There are a lot of questions surrounding where credits are coming from and when, as well as how much and for what they are paying. “Oddly enough, this has turned into an industry where everything seems to be a surprise. Where else does someone hand over their wallet and essentially let others put in and take out whatever they deem to be owed or due? How has that become an acceptable, normal practice,” questions David Silvis? “Really you are just asking for problems and that is why we will not conduct business that way.”

In addition, United Rx Solutions wants to make sure that they advise on crucial healthcare compliance issues that could literally cause financial devastation for a pharmacy. “Hefty fines for infractions that they weren’t even aware of are the last thing a struggling pharmacy needs,” adds Christopher Louis. “People are unbelievably grateful when you bring a critical oversight to their attention.”

Of course, when it comes to service, these gentlemen will expect nothing but the best from their on-site representatives. All four partners started their careers in that very position. They know that the team in the field is the true “front door” of their organization. “You get to know the person that comes to your pharmacy every so often.

That’s the face that you recognize, that is where your loyalty lies,” said Van Schuette who considers himself the first on-site service representative in the pharmaceutical reverse distribution industry. “This is exactly why it is so important for us to treat our staff the right way so they will do the same with our clients.” To the partners of United 18

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Rx Solutions, the “right way” means being honest and disclosing the pertinent information that provides their clients with clarity and security as well as operating under the guide of, “Integrity First.”

Having just received their DEA license, United Rx Solutions is extremely excited to get started and “kick things up a notch.” The mission statement on their website says it all - “…..returns is not just our business, it’s our passion!”

United Rx Solutions goal is not only to provide industry solutions, but to also provide peace of mind.

L to R: David Silvis, Christopher Louis, Van Schuette and Robert Dooley

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The Pharmacy Choice online network is collectively the most popular destination on the internet for pharmacy professionals.

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Combined, these portals are the most visited websites in the pharmacy industry.

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Rx Career Center is home to the largest job board for pharmacy professionals. Job candidates can search career opportunities using a secure and confidential system. Employers have the ability to upload their open jobs and search résumés.

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THERE’S SOMETHING MAGICAL ABOUT MONDAY. There’s some sort of cosmic force that causes things to all happen all at once on this day. If you’re a pharmacist, pharmacy technician, pharmacy owner, or work at a pharmacy, you’ve known this for years and have just come to accept it.

W

Let’s review a recent Monday to illustrate. e open at 9 am. I get there at 8:45 am to turn on all the computers, enter all the passwords, open the gates... all the stuff necessary to start the day.

By 9 am I’m done signing off on all the records and printouts from the previous day. I start to work on the queue of “waiters” that used the automated system and scripts due on this day. One of them is for Mr. Wheelbarrow and his Oxycodone script that had a note of “do not fill until” today’s day. It’s the first that I print a label for filling.

9:01 am ~ The phone rings. It’s a lady that wants to know when we open. She bypassed the thing that said “For hours of operation, press 3” and pushed through to speak to a pharmacy staff member. After my greeting, she asks, “Are you open?” I reply yes. Oddly, she then asks, “So I can come get my prescription?” I don’t know why people do this. When she asked her first question, should I have said, “Yes, we’re open, but you can’t have any medication today.” Instead I’m polite, finish the conversation, and continue to work on the labels. I get a few printed for filling today.

9:05 am ~ Mrs. Wheelbarrow is at the window. She’s waiting for her husband’s medication. Her and I have both been down this road before and that’s why I printed his label first. I hold it up in my hand to show her that I have the label printed and that I’ll need a few more minutes.

“HOW LONG WILL THAT BE?” she snorts at me. I want to say “3.65 minutes” but instead say “10 minutes.” She rolls her eyes and wanders off.

I step away from the printing station to the filling station so that Mrs. Wheelbarrow doesn’t blow a gasket. I get the medication filled and double-counted and labeled with happy little oxy tablets inside. Oddly, no one ever shows up for their Simvastatin right at opening. It’s always opiods.

Ring... ring... There’s the phone again. This time it is a drug rep wanting to know when the manager will be in because he has a killer deal on something. I tell him that corporate handles all those decisions for us, just as I have 1,000 times before, but here’s yet another job so some guy can wear a suit and a tie. pharmacy edge 23

9:09 am ~ Mrs. Wheelbarrow is back. It hasn’t been anywhere near 10 minutes, but I can’t push my luck with her. One time I didn’t put in her club card info FOR her, she complained, and was given a $25 gift card.

I’m already dangerously close to another complaint with this situation. “Customers wouldn’t bother to complain unless they have a valid reason,” a regional manager once told me.

9:11 am ~ I look up to see THREE people in line at the drop off window. On my way there the phone rings.

I answer it with the intention to put the caller on hold. “Goofmart Pharmacy,” I answer. “Is this the pharmacy?” I couldn’t help myself. “Yes, that’s why I said GOOFMART PHARMACY.” A brief moment of silence, then, “Well, I wanted the bakery.” I transfer the call to customer service because we’re not allowed to keep the extension numbers posted anywhere. That would look like we’re actually a pharmacy and nobody from corporate wants that.

I get to the drop off window and there are now four people in line. The first wants to know where the blood pressure machine is, which apparently is really hard to find because it’s less than 10 feet behind her on aisle 8.

The next guy has a... you guessed it, a script for Adderall and has to wait for it. Oh, and if it doesn’t go through insurance, he’ll be glad to pay cash for it. I tell him 15 minutes and he goes down to the pick up window and stands there looking at me. He could use our nice comfy waiting room, but no, he can’t stare at me from there.

The third person in line has new prescriptions from urgent care. It’s the same three prescriptions they give to everyone regardless of their condition. Augmentin, Flonase, and Phenergan with Codeine. I swear we should have macro keys for all three of these. Just enter the patient name and the computer would populate all the info for these three scripts and print them out. It would save oodles of time. My momentary time saving thought is interrupted by the phone ringing. But at the same time the blood pressure lady has pushed her way to the counter and is barking at me about the accuracy of the FREE service we’re offering the world.

“I’ve NEVER had a reading so high!” she’s yelling. YELLING. Is she yelling because of the reading or is her agitation WHY she has blood pressure to begin with? If I actually had time to be a clinical pharmacist we could discuss this in calmer circumstances. Instead I tell her to go sit down in our waiting room, wait ten minutes, and then do another reading. She walks away, mumbling to herself.

The phone stops ringing. The guy at the register continues to stare at me, except to take a moment to look at his watch and then back at me. I finish up printing the new three scripts from the urgent care place and tell the lady it will be 20 minutes. She says she’s going to go get some chicken soup and she’s off.

The phone rings again... I ignore it.

I’m finally to the last person in line. She looks like she’s 14 years old and is wearing a company name tag.

She sticks out her hand and says, “I’m Emily. I’m the new clinical pharmacist from corporate and I’m here to talk to you about our new MTM initiatives we’re promoting at the corporate office.”

I’m shocked. The company sent out a 14 year old girl to discuss MTM with us ON A MONDAY MORNING? She can see the look on my face. “Is now not a good time?”

Provided by Crazy RxMan – Your Friendly Druggist For more great post from Crazy RxMan please visit his blog at: crazyrxman.blogspot.com.

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