Pharmacy. Jim Plagakis. Pharmacist

“Why do you do that so much, Jim?” said a member of the out-front management.

“What?” I was re-stocking a few OTC products that had been left on the pharmacy counter.

“I see you out front talking to customers all the time. The other pharmacists usually just tell them what aisle to go to. You practically take them by the hand. You take our private label off the shelf and put it right in their hand. I have heard you say, ‘Saving you money is my job’. Why do you do that?”

“I do it because I love it. It is a chance to make a difference. The private label is a no-brainer. The quality of the products cannot be questioned. It saves the customer money and the company makes a better return on investment.”

The ‘love it’ part gets more points on a scale of one to ten. I know that I have bitched mightily about not getting paid for providing valuable triage services in other places.

What I am talking about here are the warm fuzzies I get from helping people, the satisfaction I get when a worried mother’s face relaxes, the sincere ‘thank you’s I get when the meager offerings of their pocket book is able to afford an OTC that just might help.

I even pay sometimes. Sick of Stupid People writes big checks to help her patients who would have to go without. I don’t put out big money. I give a few dollars here, a few there, because it makes a difference. I sometimes think that we are, after all, the only medical professionals who see real, feeling, hurting human beings. The others see cattle.

On a Friday night, about 9:00 PM, a young woman asked how much her Rx for SMZ/TMP DS would cost. Her husband said that they had just enough, but it was in a safe place in the car. When I was talking to her while we waited for the money, I asked if she had any stinging and burning. (Have you noticed that these guys are not writing for phenazopyridine on a regular basis? What’s up with that? There is pain!)

“The stinging is terrible.” She frowned. Her husband was back.

“I can help that for less than six dollars,” I said.

She looked at her husband who said, “I will only have about three left after I pay you.”

I paused. “I’ll pick up the balance,” I said. He paid in quarters, dimes and nickels. Their emergency money.

I got my wallet out and settled with the company. “Are you hungry?”

They looked at each other. “We’ll be okay,” the husband said.

“Where are you staying?” Galveston is a resort/vacation spot. They were from West Texas. Galveston? With no money?

“My aunt invited us down, but there was a note on the door. She is gone until tomorrow. We’ll be alright. The van is big. We’ve slept in it before.”

“Are you hungry?”

“Yes, we are.” They both avoided my eyes. I gave them a twenty.

Certainly not Saltgrass money, but there is a Taco Bell right down Broadway.

I felt real good. They may have taken Jay Pee, but it is on them. I paid some karma off. If they frikkin’ worked me and ended up in the van laughing at me. well.. it is on them. Bad karma. They will pay.
Is that practicing pharmacy? Yes, I think so!

Oh, the Rx came from UTMB emergency. This poor medical center has the 19th century duty to give free medical care to indigents from anywhere in Texas. It is not sustainable in the 21st Century.

Emergency! I can see the value of the in-store clinics where a nurse practitioner could prescribe SMZ/TMP DS for twenty bucks.

Why can’t they have cheap/free clinics where these people can go? Unnecessary Emergency Room visits drain the entire system.

I just needed to stretch out. I have a lot to say. You will too after you have had your-feet-on-the-floor in a pharmacy department for a few decades.

The old theme was just too restrictive. This one offers a lot of options for me and for you. What I want to do most is inform you, entertain you, humor you and have fun doing it.

The flowery meadow in the spring theme is apropos to my “love child” life in the San Francisco Bay Area. I was a weekend “hippie”. My hair was well over my ears. I wore the clothes. I talked the talk. I did it all except “drop out”. Gimme a break. I worked hard to get my degree and licenses. It was time to practice pharmacy and make some money.

I spent many Sundays sitting on the meadow in Golden Gate Park with sourdough bread, heavy red wine, cheese and salami. We listened to the free concerts. “The Dead”. “Janice”. “Havens”. One Sunday, I said to my wife, “They are playing Beatles songs.” It was the Beatles. Wine was my drug. Too much wine , but I was in my twenties. The drinking culture was still very strong in those days.

There are terrific stories from this time and I’ll tell them and many others. I have had both of my feet solidly in the drug store, pharmacy culture since my first job as a stock boy. That was 1957. That is 50+ years.

This main page, by the way, will remain a relatively purposeful commentary on our profession and the job of working in a pharmacy.

This will be like the ocean. A study of fractals that follow the tides. You watch pharmacy and it seems to be the same, like the waves, every day
until it is not the same. I like to watch for those episodes.

Some of you might want to avoid some of these story lines. There will be
“adult” content. I WILL WARN YOU. If you sneak a peek, I won’t tell. Those forbidden pleasures are the most delicious.

When you click on the pages up above look along the top margins for the sub-pages. There will be layers. Just keep looking until you find something that appeals to you. In order for you to leave “comments”, I’ll have to make every post a new page. So prepare to dig deep. The comments button is to the left, right below the date.

Explore. Right now we are “Under Construction”, but have fun.

PS: Just because I haven’t written anything yet for some of these pages, you can still write “comments” if you get motivated by the title of the page. Just have fun.

This is about one doctor and one gonna-be-a-doctor.

Naomi is my daughter-in-law. She is a doctor of osteopathy and doing her residency for cheap money in Medford, Oregon. She is writing prescriptions.

Lena is my neighbor. She is a medical student at the University of Texas Medical Branch. She is married to Barry who is an airline pilot. She is a Registered Nurse, but got so sick and tired of being bullied by MDs that she decided to become one.

Lena and Barry met in Alaska. Lena is from Moldava. Her mother, had a full career as a medical doctor in Moldava. Now, grandma is the primary caregiver for Lena and Barry’s five year old autistic son.

Both of these girls told me the same thing with a question in their tone. Their schools had told them to treat pharmaceutical reps as rattlesnakes. They were told they had to sign an ethics code that would be in force for their entire careers. They were to take nothing. No gifts. No meals. No pens and pads. They were supposed to swear that their ears would be closed to any words from the reps, that they would never let them into the office. No donuts for the staff. No movie tickets for the receptionist. Nothing.

They both asked, “What do you think about that, Jim.”

Here is what I told them both. “That is ridiculous. You are going to be a wage-slave who works your 40 hours and go home. The days of fee for service is heading for the dead end. You’ll make very good money without the headaches. There will not be a four car garage with a Jaguar, Mercedes, Chevy Truck and a Range Rover. Your house will not be 6,000 square feet. You won’t own a condo at the south shore of Lake Tahoe and a beach house on Monterrey Bay. That is what dentists are going to be able to do.”

I asked them where they got their drug information and they both told me advertising in the journals with some embarrassment. “You are not going to come home from work every night and read about drugs. I know you want a life. The drug reps are the best educated on their drugs in the world. They are the best educated on the drugs that may be elbowing their way in. In five minutes, they will educate you about what the drug does, how it does it and if there is anything to be worried about. What more do you need?”

They were listening intently. I went on. “Modern doctors get most of their drug education from the drug reps. Why not? They will give you the highlights in minutes and the highlights are all you need.”

Then I got serious. “Beyond the highlights, you can pick out a friendly pharmacist in the community and lean on her. She will fill in all the gaps for you. You won’t be able to help it. You will favor her store. It’s a trade/trade.” They both liked this idea.

“Modern doctors have about 50 drugs that they prescribe regularly. They know a lot about those 50 drugs. If you want to go beyond and are not satisfied with the drug rep’s rap, call your pharmacist partner.”

They liked this. Then came the big one. “We shouldn’t accept gifts though, right?”

“Why not?” I said.

This is what I told Naomi. “Darling, you make resident’s money. Cody is getting ready for law school. Life is not that easy right now. When the Pfizer rep invites you and Cody for the weekend at a nice hotel on the coast in Cannon Beach, all expenses paid, and all you have to do is attend a two hour lecture on their newest drug, DO IT! In the end, you are the doctor. Nobody will force you to write for this drug. You can make your own mind up.”

Naomi wanted to know if she really could depend on a pharmacist. This was an entirely new concept, a revelation. She told me recently that she found her pharmacist partner. A mature man who had plenty of time and likes it when she calls.

“Jim, I will not talk to this man. He is impossible.” This technician is usually implacable. She is a veteran. She knows her job and for her to have to turn the phone over to me got my attention.

“What’s wrong?” I expected her to say that he was abusive or that he used bad language or personally insulted her.

“He says that his insurance should pay even though they say that he had the prescriptions filled in another drug store just five days ago.”

Hmmm. I drew a breath and picked up the telephone. I didn’t cock around. I just said, “Where did you have these medicines filled just five days ago?”

Silence. “Nowhere,” he said.

“Your insurance company thinks you had them filled at another drug store. If that is not the case, then someone is committing fraud in your name. I think that I better call the District Attorney about this since we are involved.”

“The who?”

“District Attorney”. I knew that I was just blowing smoke, but he didn’t.

“Well….. why?”

“To report that someone is using your identity to get drugs.” I paused. “You should get a visit from some detectives to file a report.”

“Oh… well.. does mail order count?”

“Of course it does. If mail order has filled them .. yes.. mail order is a drug store.”

“I need my medicine.”

“So, when did you place your order with the mail order drug store?”

“About three weeks ago.”

“Not about. Exactly.”

“I don’t know, but I still had three weeks of medicine when I sent in.”

“Three weeks and they haven’t gotten the medicine to you yet.”

I got his name and looked up his profile. He was a diabetic. (oral meds). He had high blood pressure. He was taking blood thinners.

“I can’t help you, sir. We’ll fill your prescriptions, but you’ll have to pay full price.. unless..”

“Unless what?” The sound of abject hope, ready to beg, is pathetic.

“Unless you get a special override from the insurance.”

“How can you do that?” More hope.

“I can’t, but YOU can.. maybe.”

“How?”

“You call them up and tell them that they have had three weeks and they have failed. You are not a well man and you absolutely refuse to pay full price when it is their responsibility to get the medicines to you in a timely manner. You tell them that you demand an override, that they have to call me because I will not call them.”

“Will it work?”

“I don’t know, but use these words, I HAVE BEEN ADVISED TO INFORM YOU THAT YOUR FAILURE TO DELIVER THE MEDICINES IN A TIMELY MANNER IS ACTIONABLE.”

“What?”

“Write it down.” I repeated it slowly.

Forty-five minutes later, his insurance company called and gave me the override codes, not just for a few days worth, but 90 days even though they already had it in the mail and gone.

There was a short essay in a national magazine about a guy who started La Clinica de la Raza, a chain of low cost medical centers in a place where the people could rarely afford the ER and who lived away from the nearest doctor with a heart.

The story of one 18 month old baby tells it all. The essay said that the child was “flu-stricken” and died of dehydration. The child probably did not have influenza, but one of a list of ailments that people label “the flu”.

The “third world” location where this happened was the United States of America. Too bad that they did not take the child to the drug store. Too bad that they did not get the attention of the pharmacist. Too bad that they did not follow the pharmacist over to the baby aisle. Too bad that they didn’t spend a couple bucks on the generic brand of Pedialyte for starters.

I am writing this to harp, once again, on my contention that pharmacists are the POINT PERSONS OF TRIAGE in the USA. Think about it. You do not know how important your advice is until they never come to you and the patient dies. You will really never know? Just trust that your advice actually saves lives every now and then.

In my practice of pharmacy, I KNOW that I am a triage person. They come to me because they want to avoid the doctor or the ER for their own reasons. They come to me because they know that I am accessible. They come to me because they know that pharmacists will be friendly, because we will help.

AND… WE WON’T CHARGE THEM.

I have a three point imperative that I follow. I use my own discretion (legally makes me a professional, believe it or not) as to what I will recommend.

1. If it is simple symptomatic relief they are after and, in my judgment, that is all they need, I recommend an OTC remedy and that is that.

2. If, in my judgment, indications are an infection or symptoms that indicate a possible medical condition like an intractable, nagging, long-lived pain in the abdomen, I’ll tell them that they need to get to a doctor.

3. If, they come to me with slurred speech, a crooked smile and a left arm that is weak, I tell them and the person who drove them to get their asses to the Emergency Room.

TRIAGE! Pure, clean TRIAGE. We are at the bottom on the medical funnel and we provide the service for free.

Now, consider the cost to the $2 trillion dollar a year medical nut, if you sent everyone to the ER.

Give yourself a hand, a pat on the fanny, a high five.

Pharmacists save the system MILLIONS OF DOLLARS A DAY. Period. If we demanded to be paid BY THE SYSTEM through legitimate billing with our own NPIs, someone would have fit. We are in a frikkin’ hole and I am not going to
lead this charge. I’m too busy.

Why aren’t we paid? More important, why don’t we demand to be paid? Why don’t we raise holy hell when our employers dare to advertise our professional services the same way they advertise the clerk at the camera department? For free! “Our pharmacists are available for OTC consultation at no charge”.

Well, fuck me then, thank you, no charge.

You guys are probably going to just blow those questions off. That is what you usually do when I ask hard questions.
JP

“thisismariannerthomasatdoctorkziekieczofficeinhoustonourcallbacknumberis2816578907doctorsdeaisak1234567. andhisnpiis1234567andhisdpsnumberisk3848577GAAAAASSPUGHHUHthisisforrosalbamontnaloherdateofbithis03121928doctorwantsatenolol. 50milligramthirtyonetableteverymorningnumberthirtyxcclorthalidone50mgeverymorningnumber30onetableteverymorningHUUHGAAAAAASPOUGHthenhewantscoumadinfivemilligrambutthisisnotjustaregular

dosedoctorwantsonehalftabletonmondaywednesdayandfridayandtwoandahalfmilligramsonesatrudayandsundaythelastoneisUUUGHGAAASPPUUUHimnotsureithingitisnefipine?isthatlikeplavix?

thedoctordidntsayplavixbutimsurethatiswhatheisprescribingsoisplavixnefipineyesitisimsureplavixeverymorningquestionsaammarianethomasat2816578907ARRRRGHGASPHISS HUHMOAN.. (Severely edited for brevity)”

“What the fuck? Goddam, woman. Slow the fuck down.”

Pity me, I am pathetic. I was talking to the telephone VOICE FUCKING MAIL.

Two technicians turned and stared at me. The younger one was smiling. The older one was frowning.

“What’s wrong, Jimmy,” sang the young one. The older one crossed her arms.

“Sorry………this woman talked so fast on this voicemail that I will be here for the next half hour, starting from the beginning, listening and writing.”

Of course, there is no pausing or rewinding. The company’s technical mavens don’t give a shit about us. No one ever gave a thought about it.

REWIND! They think we are attorneys and have secretaries to transcribe the voicemails.

I had to listen to this forcrissakedamnit voicemail eight goddam times to get every thing and that is with a margin of error of about 30%.

She never gave me the refills and I did not solve the NIFEPINE / PLAVIX piece of shit damnnit problem without a phone chase that took three goddam hours. Of course, it was nifedipine. But she did not leave the form, the strength, the directions, number of doses. This was mess. The frikkin doctor,obviously allows ambiguity and uncerttainty, but we can’t. We are the one who actually put the pill in the patient’s mouth.

Here we go, my chicken-shit colleagues. I consider myself one of you, by the way. I am the number ONE institutionalized goddam chicken shit druggist in the USA.

WHY DO WE CONTINUE TO PUT UP WITH THIS?

HOW CAN WE JUSTIFY OUR TOLERANCE OF VOICEMAILS LIKE THIS ONE?

HANDWRITING IS THE “TURD IN THE PUNCHBOWL”. EVERYBODY SEES IT. WE ALL KNOW THAT IT IS FLOATING THERE.

OTHER THAN VERY FEW WHISPERED, “Geezus, do you see that piece of shit in the party punch?”

“What piece of shit?”

“THAT PIECE OF SHIT. That one floating in the punchbowl. Are you blind?”

“Oh, that piece of shit. That turd has been floating there for years, decades.”

I am generous right now. My abject fury over this is moderated by the holiday. It is going on three months since the storm. The gnats that clustered all over town are gone. They were all over the pharmacy. They got in my nose. The big, fat, slow-flying houseflies are gone. Even the odors of decay, like a summer garden in decline are almost gone.

There are still new debris piles all over the place. You can go to a favorite lunch place in the historical district and it’s 50/50 if it will be back.

You can find 40 foot sailing sloops and one 50 foot ketch on their sides right beside 61st Street. They are big. They are mega-expensive. The state is hesitating to move them because the owners need to bear the expense. Chances are that the owners have abandoned them. No insurance. What a loss.

It is Christmas Eve and my one year old grandson is at my feet pretending that he is a nurse on a voicemail. BRRRRDDD. He likes bee words. BAAABAAA. The Kroger Store is his “Disneyland”. KAAARRRG.

So, this is not the time, my friends, to whine about HANDWRITNG and VOICEMAIL.

But… I am really pissed off at you and me. How many times will it take for 5 pharmacists to send back prescriptions to be re-written before the prescribers realize that the duck has been fucked?

Washington State has made an attempt to stop the handwriting fiasco. I only know that cursive has been banned. Perhaps, Jeannette down around Olympia can tell us about it. Does it work? Please, please tell me that the Pacific Northwest has won another one.

We look like the clowns of the medical professionals over the give-away prescriptions, our work hours, and our look-the-other-way about drug seekers. We are the arm-pit of medicine when we let the PBMs run our reimbursements and the profits we can make. AND MORE, AND MORE.

I’m just sick of it. Let me hear from you. Make me feel better.

PS: I wrote a little book that is for sale here. WRITING PRESCRIPTIONS SO THE PHARMACIST WILL LOVE YOU.
I redesigned the cover and the title to: IT’S YOUR HANDWRITING, STUPID! (Will your patient get the right drug, in the right dose, at the right time or WILL YOUR PATIENT DIE?

Don’t let the supercilious motherfuckers shit you: Patients HAVE DIED because of handwriting. This is fucking manslaughter. Wrongful death. Relatives need to get smart and take a good look below the surface when a loved one dies unexpectedly.

Now, a minute for a couple vinyasas, a half sun salutation and a twist or two to squeeze the blood out of my internal organs and let fresh, oxygenated blood flow into them. An inversion appropriate for an old man is downward facing dog. Good to have my organs free-floating and fresh blood will flow to my brain.

I’m good now. Gonna take my wallet to Target (Fuck Wal-Mart) and walk around. When I drive passed the corner where there is a CVS and a Walgreens, I’ll open the wind and spit out all of today’s handwriting poison.

Happy Holidays.

There is a Nurse Practitioner at Student Wellness at UTMB who calls on the two days a week that I work hoping to catch me. This is a nice for my self-esteem, but I just realized last week what I do that makes her search me out.

“I am glad it’s you,” she said. Then, she started to ask me about prescribing Cialis.

I said to her, “Terry, you are at Student Wellness. This kid is just 24 years old. Why in hell does he need Cialis?”

“I honestly don’t know,” she answered. “He just said that he needed a prescription for it.”

“He didn’t tell you why?”

“Well, he said that he needed it for his love life.”

“And you are going to prescribe it?”

“Well ,,, Yes. Shouldn’t I?”

“He’s got you, Terry. He just wants to be super-stud-sex-machine-medical-student.”

“You think so? Why do you think so? Would it really make him able to.. uh.. perform better?”

So, I told her all about Cialis. The whole 36 hour deal. The fact that modern young men like to have a reputation of being supercharged in bed. Word gets around. Modern young women expect more these days.

“Is it dangerous for him to take it?”

“Probably not,” I said. “As long as he doesn’t use poppers.”

“Poppers?” She laughed. “Poppers, Jim?”

“Amyl Nitrate.”

“What’s that?”

So, I told her. “They pop it under the nose at .. the moment.. and wow.”

“Oh gawd, Jim, really?”

“Really, Terry.”

“Should I prescribe it, Jim?”

I thought to myself, WHY NOT? “It’s up to you, Terry.”

“I will then. What strength should I prescribe?

I told her all about the pricing, that cutting a 20 mg was much more cost effective than prescribing a lower dose. So that’s what she did.

“What should I say? A half tablet?”

Geezuz, girl. Do I have to do everything? “One-fourth or one-half.”

“Will it really work, one-fourth?”

“Terry, if this kid is healthy, at 24 years old, all he’ll have to do is smell it.”

“Ah, Jim, thanks. This is like the old days, when we all shared information.”

What the? What exchange. The information went only one way. What old days was she talking about?

We answer questions all day long. We give valuable information to patients,the parents of patients, the aunts and uncles of patients, to the police, to insurance companies, to the prescribers and WHAT DO WE GET FOR IT? Absolutely nothing. We get behind.

Paul Garbarini, the Boston lawyer who is Legal Counsel for The Pharmacy Alliance, is laughing to keep from crying. He is a pharmacist and an attorney. He knows about getting paid for his knowledge and expertise. We are so frikkin’ dumb.

The entire conversation took about five minutes. I took this Nurse Practitioner from a standstill on Cialis to running speed. I was paid nothing. She didn’t even say Thank You. I gave her five uninterrupted minutes. Where else could she find that? That is when I realized why I was such a favorite.

Who is going to be the first pharmacist to send an invoice. You can put on the subject line: CIALIS CONSULTATION FOR BIG STUDLY MEDICAL STUDENT.

I want to take this opportunity to extend a hearty welcome to Wal-Mart. Someone from Bentonville, Arkansas has been lurking here at www.jimplagakis.com. As recently as 8:40 AM today, “walmart.com” has been with us, right here. Snooping, taking a look.

What is this all about? Do they want to get a heads up? A competitive advantage from reading what I write and what pharmacistS have been writing on the MESSAGE BOARD?

Hardly. They are probably thinking that old Jay Pee is a subversive and can harm them somehow. I know. Don’t hurt yourself when you fall down in a laughing spasm.

I recently installed “SiteMeter” so I can see what is going on at “JP.com”. I will make some big changes soon to satisfy appetites that I discovered have not been satiated. I NEVER EXPECTED TO SEE THAT WAL-MART WOULD BE WATCHING.

Perhaps, it was someone using the company’s address and Internet connection to look at “JP kinda Wal-Mart pseudo-porn”. I can see a constrained and suppressed pharmacist getting a thrill out of my kind of Wal-Mart wickedness and irreverence.

Wal-Mart has a lot of money. They are almost as big as a government. The can afford to put a full time position to monitoring “jimplagakis.com”, “thepharmacyalliance.com”, “theangrypharmacist.com”, “the angriestpharmacist.com”. The guy who coined the term GALLEY SLAVES when referring to institutionalized pharmacists, “theoleapothecary.com” probably has Wal-Mart snoopers watching him.

Scary, isn’t it? So, I don’t want to cause anyone to get laid off at the offices in Bentonville, but I want my viewpoint to be “transparent”. It always has been. JP has never been shy about telling what he believes is the truth.

Here we go. So you don’t have to “lurk” at JP.Com. If you are not the guy at Wal-Mart stop reading right now. This does not concern you, in your safe and warm cocoon.

WAL-MART IS NOT AND NEVER WILL BE A DRUG STORE COMPANY. CVS, for all of its faults, is a drug store company.

WAL-MART is WAL-MART. This company is opportunistic. If a pharmacist follows the company line, they can have a relatively smooth working life. A working life without dignity, self-respect and integrity. Don’t even think about it. Maslow does not make sense here. If GALLEY SLAVE is appropriate, it works here.

The $4.00 prescription strips the entire profession of the patient’s perception that PHARMACISTS PROVIDE A VALUABLE PROFESSIONAL SERVICE that cannot be obtained anywhere else. The $4.00 Rx is not a public service. It is a dingy marketing tool. My suggestion is that all companies leave it up to the pharmacist as to who is a “poor patient”.

That was the norm 4 decades ago. The doctor would write “PP” on the Rx. It was code for “poor patient”. I always, in 100% of the incidences, followed through with a retail price of bare bones acquisition cost OR LESS. The LESS usually came when it was a child with an earache. I have a thing for children with earaches. Perhaps because I can still remember what it was like.

The $4.00 Rx is a travesty as a public health service. To make sure there is no mistake. TRAVESTY: TO IMITATE OR RIDICULE SOMETHING IN A GROTESQUE OR DISTORTED MANNER. The $4.00 Rx is goddam grotesque.

Now, if you are a non-pharmacist Wal-Mart middle manager reading this, I am NOT talking to you. I frankly don’t give a shit what you think. This is to the pharmacist middle-managers, the “Yes Men” who have sold their souls just to look good to their non-pharmacist bosses. It is a sick kind of corporate incest. It is just as bad as Britney Spears French kissing Lindsay Lohan.

Can you imagine that first conversation?

Non-pharmacist middle manager, “Bill, how about selling some of those dirt cheap generics at $4.00 for a month’s supply?”

Pharmacist one-step-lower middle manager thinks: “What the fuck? That’s a terrible idea.” But he says, “Not a bad idea, Frank.” He thinks: “This has about as much hope as a fart in a tornado.”

Bill had his chance and he let the entire industry down. Let no one dissuade you from this idea: Wal-Mart is a very bad player in our industry. We need to shun them. We need to work somewhere else. We need to get some pride back and run away from a company that has harmed and will continue to harm the industry. They’ll throw money like crazy to get people to work for them. It’ll be on your conscience.

Pharmacists will eventually bury them. We will become the dangerous “Black Sheep” of the family. Wal-Mart will not prevail. Do they think they are dealing with high school drop out cashiers? Pharmacists will eventually win some small battles and they will get the taste of blood. You know what happens when the alpha animal tastes blood.

The only way they can continue in causing damage is if pharmacists continue to operate as free-agents and not members of a profession. We have a duty to our profession.

Do NOT ever expect WAL-MART to abide by published company policy if it will cost them money. If they can bully you into giving up, they will bring the hammer down. If you don’t willingly let Wal-Mart have its way, you are going to have to get an attorney.

A recent disability case in the Pacific Northwest tells just the way it is. A PIC at Wal-Mart wanted them to simply abide by “the book.” That pharmacist now has an attorney.

So, Wal-Mart man. Welcome to my world. What I wrote above is so you don’t have to hunt so hard. I would guess that many of my loyal readers will have their own comments. Try to keep it above the line, you who have your mouths full of profanities reading this.

Remember, if Wal-Mart can lurk at Jay Pee.com. They can be in your bed room.

The Angry Pharmacist was recently talking about “DAW-1”. It is an indication that the prescriber insists that the pharmacist dispense the brand name and not the generic. For you casual readers: The pharmacist has no choice. He must dispense what the prescriber has written if DAW-1 is indicated.

For example. If the doctor writes: BRAND NAME NECESSARY in her own handwriting (The only way to get DAW-1 in Texas) the pharmacist hands over Zofran instead of the generic odansetron. You hand over your entire month’s budget if you are a cash patient and your family starves. Odansetron, the generic, will cost you less than $100.00 at most drug stores. That is not an exaggeration

I don’t like DAW-1 any more than my friend The Angry Pharmacist. DAW-1 writing is damned near close to 99.9% therapeutically unnecessary. I cringe when I see it. I cringe when I have to tell the patient that she will have to pay the DAW-1 co-pay.

“But I don’t want to pay $30.00. I want to pay the $5.00.”

What do you do? Get on the phone. Waste your time and the patient’s time.

What I hate worse than DAW-1 is DAW-2. That is the patient insisting on the brand name. There is rampant insurance fraud happening when a pharmacist signifies DAW-1 when it is really DAW-2.

I have to go to the tech and ask. “I don’t see a DAW-1 on this. Why did you use the brand name?”

The tech snaps her chewing gum and shrugs, “The patient said that she wants the brand name. Nothing else will do.”

“Okay, but that is not DAW-1. That is DAW-2.”

“Okay.” She heads back to her terminal. I like watching her from behind. The way she walks. She is a strong young woman, in terrific shape. This is good for me. It is evidence that I still have something left.

I watch her work and I am taking some pleasure because I know what is going to happen. She comes back with a look.

“Jim, DAW-2 makes it come out to a copay of $112.00 instead of $30.00. She won’t like that.”

I tell the patient that her insurance insists on the higher co-pay because the brand name is her choice and not the doctor’s choice.

“Your insurance does not like it when the patient chooses the brand name.”

“I always get the brand name for $30.00 at my regular drug store. That is what I want now.” She folds her arms with an indignant frown. “I’d go there, but this can’t wait until I go home.”

“You say that you have always insisted on the brand name and have had to pay only $30.00?”

“That’s right.” She is an overweight woman, wearing young woman’s fashions. Her exposed belly button is lost in folds of tissue. What is she thinking? That she is sexy? Good looking? Worth staring at? Galveston can be a hot place. Practically naked is the clothing choice of some shopping females.

Your ass is grass, My Pretty, I think. What I say is, “I can call your insurance company and get advice,” I was silent for awhile. Give her some space to understand what can happen. If she is smart, she will change her tune. But, that Rx would not be signified as DAW-1 while I was the pharmacist on duty.

“Call them.” She was as stupid as she was unsightly.

This story repeats a few times a year. I call them INSURANCE OPPORTUNISTS. They are like buffet eaters who load the plate four times with the most expensive dishes. They are gonna get their $9.99 worth if it makes them puke their lungs out.

In truth, people like these are the same ones who insist on an MRI for a sprained ankle. They are the OVER-UTILIZERS who are crushing our two trillion dollar a year medical nut. My idea if everyone took only the medical care that they needed, we’d be good in the U S of A.

The example I used will stay with me. After telling the person at the PBM the story, a supervisor asked to talk with the patient. Her face turned red. All I heard was “No No” repeated a few times.

She took the generic and asked me one question before she left.

“Do you think that my other pharmacist will get in trouble for making sure that I never have to pay more than $30.00.

A follow up on the Boomers, health and YOUR OPPORTUNITY.

When I was a boy, men were very old at my age. They looked old, they acted old, they ate too good. In the 1950s, eating good was bacon and eggs for breakfast EVERY DAY. Lunch was a meat sandwich and fried potatoes. Dinner was more meat, lots of meat, a tablespoonful of peas and potatoes. The had strokes for dessert.

To give evidence of how the healthy eating phenomenon moved from the west to the east, I’ll tell you a little story from the middle of January 1965. I was in Los Angeles for the three day California Pharmacy Board exam. Morning One, we went to the USC School of Pharmacy Dispensing Lab and filled a compounded Rx.

At lunch, I wandered over near the Los Angeles Coliseum and found a coffee shop. I ordered a big-size burger and sat in a corner booth. I talked with a man named Jay. The topic was a little known place in South East Asia called Vietnam. I am either blessed or cursed with an eidetic memory. Jay wore a Hawaiian shirt, black short pants and sandals.

Jay left the coffee shop and along came a California girl (Oh boy. I had never had a young woman make eye contact for so long a time) I looked down at my plate and said, “Where are the French Fries?”

“You didn’t order French Fries.”

“Well, I did not order a salad either and there is a salad on my plate.” It was the most complicated salad I had ever seen. Three kinds of lettuce, tomato, cucumber and other assorted chunks of colorful vegetables that I could not identify.

“The salad comes with the burger. You get a salad with any sandwich.”

A salad, not French Fries. The beginning of the cosmopolitan education of Jay Pee.

People are already making big gobs of cash money from the need of the boomers to stay youthful, vital, fully-alive and sexy. There is a guy in Vegas who advertises all over the country. His name is Doctor Jeffrey Life. He runs the Cenegenics Medical Institute.

One of his patients was interviewed recently. After seeing Dr. Life (Don’t tell me that this guy did not get his name by filing papers at the Clark County Courthouse) this 47 year old man from Los Angeles changed his diet and exercise habits drastically. He injects himself with HGH every single day and shoots testosterone once a week.

This trumps botox, wrinkle fillers, DHEA, a surgeon’s scalpel, breasts small to big and big to small. Medco reports that HGH use grew by 6% in 2007. The search for youth isn’t new, but the boomers have more money than past generations.

In 1500 BC, people were ingesting tiger gonads to rejuvenate themselves. Ponce de Leon covered Florida seeking the fountain of youth. Ponce and his gang really believed it existed. Just as people today will be led to believe quackeries by the hundreds before they shell out big money with doctors like Light.

How about the people who practically do not eat? Apparently, it works. They all look like the Olsen twins, but they are in terrific shape.

That is what I’ll tell my patients who ask for a vitamin that retards aging

“Don’t eat,” I’ll say.

“Isn’t there another way?”

Then they will buy anything I tell them to… just so they can continue eating pasta fa zool.

Remember, the game is just starting and they are saying that 95 is the new 75.

Most important for your ears. They are gonna spend money. And many will have the jack to go see Doctor Life.

They may stay at home if you prepare yourself and do the right thing.

JP