holy moly

It's been a minute since I wrote in here.

It isn't for lack of material.  Anyone who works in a pharmacy knows there isn't a lack of material, ever.

In the last few months we've had our share of WTF moments.

Some of it is relationship-based.  I am the type who'd rather spend time with their significant other rather than sit in front of a keyboard.  Some of it is related to my computer going down the toilet a couple months ago.  Some of it is being busier at work the last couple of months.

Yes, the little independent pharmacy where I reside has grown significantly in the last few months.

I'm convinced some of it is just because of the simple change that took place in late August.  My previous head pharmacist, well she meant well, but she wasn't able to provide the type of leadership and stability that this little operation needed.  In steps our current head pharmacist, and things are much more organized, much more structured.

They're just much, much better.

Of course, now the challenge becomes trying to break our newbie of some of the things he learned in pharmacy school.  He has yet to completely understand that what they teach and what actually goes on are often two very different things.

In short, he's intelligent, but he lacks what we know as pharmacy common sense.

In the short time he's been here, he's questioned whether an allergy issue has been raised or not on a medication that the patient had been taking for months, questioned a dose that someone else had been on for over a year, and pretty much anything else he sees that goes beyond what is typically recommended.

This would be fine and all except we warned him he'd see things that aren't common or go beyond what is normally prescribed.  We told him that he would have to adapt on the fly.  He assured us he had retail experience and that he would be able to adjust.

I could spend the next several paragraphs detailing how opposite everything has been from what we thought we were getting, but frankly, I've vented enough about him as is.  What I do know is the crap needs to stop soon before something bad happens.  I understand wanting to follow proper procedures and all, but real life rarely follows procedure.  You can be the smartest person in the world, but still be a bad pharmacist.

**Sidebar**

I worked with a girl for a few years as a tech who decided she wanted to be a pharmacist.  Intelligence was never her issue, but she gave true meaning to all the blonde stereotypes you've heard over the years.  She's pretty much about the glitz and has pretty much been the type of person who annoys me greatly.  Anything her company wants its pharmacies to do, she follows blindly, no matter what.  Every program, every phone call, everything.  As a result, she's moving up the ladder fairly quickly, but she'd drive me crazy.  I'm glad that I don't work in her store, well, the store she used to have as she's moving on.

In short, she's the type who knows a lot, but doesn't apply common sense to the equation.  I'm happy she's made it where she has, but maybe it's just me, but she was awfully annoying to work with the few times she filled in at my store.

**End**

The main point is pharmacy isn't just about what interacts with what and is the dose too high.  It's about what works for the patient within the legal limits.

The thing I've seen sometimes is a pharmacist thinking they're smarter than the doctor.  Look, I'll take a pharmacist's side in a lot of things, and there are some doctors where I do wonder, but generally, the doctor knows what they're doing.  It's one thing to ask why something is being prescribed, a different thing if you're trying to tell the doctor what they should do.

All I'm saying is it makes me wonder what they're teaching in pharmacy school more than ever.  Are they being realistic?  Or are they presenting students with what an ideal pharmacy operates like, rather than what reality dictates?

It seems to me that it isn't an accurate representation of what a normal pharmacy looks like.

In any case, one of the more interesting things to watch is Walgreens being involved with another spat with an insurance company, this time Express Scripts.  Some will remember a few years ago they stopped taking (or were denied depending on the version of the story you received) Medical Mutual (processed by Medco).  Some said Walgreens didn't like the dispensing fee that was offered, while a different story I heard was that Walgreens got caught with its hand in the cookie jar (in other words, improperly billing items) and Medco smacked it.  Hard.

Regardless, the story going around is that Walgreens refused to take the cut that Express Scripts tried to push on them and thus let the contract expire without renewing.  Some are lauding Walgreens for taking a stand against an insurance company, but to me it's a slippery slope.  While insurances do drive me nuts generally (and have notoriously tried to squeeze pharmacies at every turn), it's easy to forget they're trying to make a profit as well as pharmacies (and there's no disputing that the larger retail chains took in a massive profit last year).  So while they make me crazy, they are still a business trying to make money.

In short, there's a lot of concern within the pharmacy industry about reimbursement.  One blog pointed out most major pharmacies make their money off brand name drugs and that the number of big name brand drugs is dwindling quickly.  Very few are left any more and there isn't anything coming down the line to offset all the new generics coming out for the aforementioned big name brand drugs.

Independents tend to get hurt most in situations like this.  They are the ones who get squeezed hardest by insurances just because they don't have the clout that a CVS or Walgreens has.  They can't just sit up and say "we won't take your insurance then" and then cover their ass with the other plans they do take.  If an independent loses a carrier, it's possible to lose a significant chunk of what little business they do have.

It's a slippery slope.

For now, a place like where I work is going to be okay.  A majority of our business comes from people on welfare and right now, aside from Medicaid branching back off again into managed care providers, things are relatively stable.  The spat between Walgreens and Express Scripts is nothing more than something to amuse us when we get bored.

Here, life is relatively good.

Let's hope it stays that way.