Monthly Archives: September 2012

Cost. Quality. Access. Guest Post by @Pharm_Thoughts


Thanks to @Pharm_Thoughts for this guest post about the US healthcare system. [I have wrote one on the NHS and prescription exemption which is for her blog readers in America]


I was once told these were the three problems every health care system in the world faced. You change one, the other two are affected. By and large, I have found this statement to be true. The one most people are focused on today, though, is cost.


We all know the cost of health care is rather hefty, regardless of whether it’s paid for by the government or by the patient. Between practitioner costs, diagnostic tests, blood tests, surgery, and medications, the costs can increase at an astronomical rate if a patient has a multitude of problems. This list is nowhere near all inclusive, as the term “health care” encompasses so much. Medications alone can get very expensive. I couldn’t even imagine having to pay out of pocket for everything. The one thing that’s really intriguing about it all, though, is the difference in the way health care is paid for in different countries. I’m going to review the health care system of the United States, focusing mainly on the retail pharmacy end of it, since that’s my area of expertise. To be even more specific, I am going to focus on private insurance companies, not government run programs, like our welfare programs or the insurance for our federal employees.


The United States does not have socialized health care. That is currently a huge political debate going on over here. There’s always some “hot button” topic going on during presidential election years, and that’s one of the topics of choice this time around. But, anyway, in the US, health care is almost more of a privilege than a right. Unless you fall into the welfare bracket, you have to find your own way to purchase health insurance, whether it be through an employer or through a private insurance company. There is actually a rather large number of people over here who are uninsured (49.9 million people is the most recent statistic). The only upside to this system is that supposedly our access to care is much greater than it would be if health care was paid for by the government (ex. I can get in to see my primary care physician as soon as the next business day if needed, but if we had national health insurance I may need to wait a few weeks before an appointment slot is available). I once thought this trade off wasn’t too bad, but that was before the economic recession hit here. Now, I’m not so sure.


Even though I have worked in a pharmacy setting for a huge chunk of my life now, I still find the insurance aspect of it mind boggling and frustrating. Pharmacy staff members spend at least 33% of their time dealing with insurance based problems in most US pharmacies. Most of these problems are easy fixes, but it still eats up a lot of time that could be better spent actually helping patients. This doesn’t even go into the auditing portion of it all. As an intern, I once spent a few hours with auditors from a major insurance company who were conducting audits on random prescriptions filled at pharmacies across the country. I had to go through hard copy scripts that were dated as far back as five years prior to that date. Five years! What a waste of time. And for what? The pennies that they paid for some prednisone and amitriptyline? There weren’t even any super expensive medications in the chunk of prescriptions I pulled for them. But, I digress. The point of that rant was just to emphasize how much valuable time is wasted with insurance companies when it could be better spent elsewhere.


Pulling my focus back to the medication area of US health care, there is one thing that needs to be understood. Here in the States, medical coverage and prescription coverage are two different things. You need to make sure you are paying for both coverages. People can easily make the mistake of only electing medical coverage and then not having any of their prescriptions paid for. Some places of employment provide prescription coverage for no extra charge as long as you have chosen medical coverage.


Not everyone is that lucky, unfortunately. To sum this portion up, US citizens have prescription coverage as a separate entity from their medical coverage. Every private insurance company is different when it comes to how much they charge and what medications they cover. Sometimes, they determine which pharmacies you can fill prescriptions at (usually big retail chains like Walgreens and CVS), and other times, they require you get maintenance medications from a mail order pharmacy. This is a major reason for the closing of many independent “Mom N’ Pop” pharmacies that have been around for half a century or more. As a general rule, medications fall into predetermined brackets or tiers. The bracket or tier the medication falls into determines what the patient owes. I will use my own prescription plan as an example:


Tier 1 – medications available as a generic (hydrochlorothiazide, lisinopril, metformin) — These are the cheapest medications. For me, these would be 7.50USD for 30 days’ worth or 15USD for 90 days.


Tier 2 – brand/proprietary drugs that are preferred by the insurance company (Benicar, Januvia, Crestor) — Generally, these are brand/proprietary drugs that do not have a generic available yet, but are considered a first line choice. These are slightly more expensive, since there is always a huge push to have people get as many generic medications as possible to decrease cost. For me, the insurance company would pay 80% of the total cost for 30 days’ worth.


Tier 3 – brand/proprietary drugs that are non-preferred (Aciphex, Testim, Omnaris) — Usually, these are brand/proprietary drugs that either have a generic available or can be substituted with a generic medication in the same class of drugs. These medications are even more expensive. Many people unfamiliar with health care costs sometimes think the price they are seeing is the actual price of the medication, when in reality, it’s a copay. For me, the insurance would only pay 65% of the total cost for 30 days’ worth. Specialty Tier – These include biologic agents, such as Humira, Enbrel, and Norvir. For me, they would cost 75USD for a 30 day supply. Non-covered – Generally speaking, these medications tend to be cosmetic or not medically necessary. The patient will be required to pay the full cost of the drug if they wish to use it. Latisse and Vaniqa are two big ones that almost every insurance provider does not cover. Also, weight loss drugs like phentermine fall into this category a lot. I would have to say that I am very lucky with my coverage. There are some people who pay much, much more for medications. I had a man with cancer come in the other day and refuse to take home his enoxaparin syringes because they would have cost him over 3,000USD. I urged the patient to get in contact with a patient advocate or prescription assistance program because of how important the medication is to his health. It turns out his insurance company moved the medication to a higher tier, which required him to pay more.


This whole tier-based system gets very confusing for many people and is far from fair in a lot of cases. Medications can change tiers from one year to the next. The formulary list is voted on by the insurance company’s executive panel. Though the panel does include health care professionals, it also includes business minded people. There are many times, both as a technician and as a pharmacist, I have called the insurance company for clarification on the price of a medication and have been told the patient’s individual plan or the medication formulary has changed since the patient had it filled last. That’s about as basic as I can get trying to explain the mess that is United States prescription drug coverage.


As a whole, the US health care system could improve a lot. I wouldn’t call it completely broken, but it’s far from perfect. Very far. But, then again, is any health care system truly perfect, or are we all trying to find ways to improve? You tell me.


You’re the pharmacy that I want

Ever wondered what Danny and Sandy really meant? Thanks to the anonymous person who also wrote ‘Breeds of Pharmacists’ and ‘Badges’ for their help with this.

D= boy/ Danny


B: both

G: Tell me about it stud!

The new counter assistant is hot

D: I got chills, they’re multiplyin’.

I have flu like symptoms

And I’m losin’ control.


‘Cause the power you’re supplyin’,

My tens machine is on..

it’s electrifyin’

too high a setting

G: You better shape up,

I expect great advice

’cause I need a man

from a pharmacist

and my heart is set on you.

No other option available to me

You better shape up;

I expect the branded stuff

you better understand

My auntie has medical training so I know what I want

to my heart I must be true.

I love honesty

D: Nothin’ left, nothin’ left for me to do.        

I am currently out of work

Both: You’re the one that I want.

Boots is shut

(you are the one i want), o,o, oo, honey.

Otherwise I would go there

The one that I want.

I can’t see a doctor for two weeks

(you are the one i want want), o,o,oo, honey.

Otherwise I would go there

The one that I want

The wait at the walk in centre is too long

(you are the one i want want), o,o, ooooo

I hate you

The one I need.

I’m desperate

Oh, yes indeed.                                                          


G: If you’re filled with affection,

You need to lose weight

you’re too shy to convey,

Speak up child!

meditate in my direction.

Don’t come near me

Feel your way.

Don’t touch me

D: I better shape up, ’cause you need a man 

I better see an improvement from this medicine

G: I need a man who can keep me satisfied.

I wish it came in chocolate flavour

D: I better shape up if I’m gonna prove

I better be cured tomorrow

G: you better prove that my faith is justified.

Otherwise I will contact that PCT thingy

D:Are you sure?

Anything else I can help you with?

Both: Yes, I’m sure down deep inside.


Both: You’re the one that I want.

Boots is shut

(you are the one i want), o,o, oo, honey.

Otherwise I would go there

The one that I want.

I can’t see a doctor for two weeks

(you are the one i want want), o,o,oo, honey.

Otherwise I would go there

The one that I want

The wait at the walk in centre is too long

(you are the one i want want), o,o, ooooo

I hate you

The one I need.

I’m desperate

Oh, yes indeed.




I love the fact that people even read my blog. However, some people scare me. The following are search terms that have resulted in people finding my blog:


  • Jedward


  • locum pharmacist claiming for entertaining


  • Is it legal to wear flip flops in a pharmacy?


  • Can pharmacists wear skirts?


  • Is methadone the same as nightnurse


  • Can I take temazepam with metatone?


  • Mr didpenser


  • Home smells like strawberry medicine


  • The miserable pharmacist blog

Pharmacy Staff Night Out


After a long week of dealing with awkward customers, the pharmacy team decided to go out for a meal on Saturday evening. We got there and were told that there would be a 20 minutes wait. Understandably we got mad and vented our anger on the waitress.


We sat down and waited patiently. Ten minutes later, the senior tech shouted that we had been waiting 20 minutes. The waitress looked flustered and said that it was their busy period and they were short staffed. That’s not our problem!


There was another party waiting too. Once they heard our heckles, they joined in. We discussed how the service had gone downhill and how it was quicker in the restaurant down the road loudly so that the waitress could hear.


We were still waiting and a couple came in and got seated straight away. The senior counter assistant got up and complained! The couple had apparently been in before and were calling back. We did not believe a word and gave her a dirty look.


Finally, we got seated. The waitress came to take our order. I was busy talking on the phone and told her to come back for my order. Everybody else ordered.


Once my call was over, I had a look at the menu. I could not believe how expensive some of the items were. There is no way that I can afford this. I made this known to the waitress and then tweeted about it on my new iPhone 5.


They did not have the food that I wanted in stock. They had ran out but would have some in tomorrow. I was not impressed at all. The junior tech stood glaring at the waitress all the time while we were waiting for our food. This speeds things up apparently.


Two of the waitresses were stood around talking about last night’s television while we were waiting for our food. We could not see into the kitchen but could hear laughter. They were obviously not doing anything. How long does it take to slap a bit of food onto a plate!


The food was served. I asked for a word with the chef. He was busy. This annoyed me. The junior counter assistant was not happy with her tomato soup. She only likes Heinz brand. She told them that she would begrudgingly accept it this time but would take her business elsewhere if they did not keep her brand in.


The Chef finally came out. I asked for a word in private. I asked him how to get my Yorkshire puddings to rise. He did not seem impressed.


Oh well. Back to work on Monday to those awkward patients!




How to hit 400 MURs


This is guidance from one of the multiples on how to achieve that 400 target:


  • Patients on none or more tablets are eligible.



  • Don’t waste time on the 10 item plus ones. Time is money!



  • When taking a prescription off a patient, ask them if they are alright. If they say yes, BOOM! Put it through as an MUR.



  • No time to do them? Let your summer student have a go.



  • MURs on antibiotics are allowed.



  • Do one on your spouse, children, parents, uncles and Great Aunt Mildred who is 98 and only takes Zopiclone.



  • Babies who use Ibuprofen suspension. Targeted MUR…


  • Ask patient if they want a beer in the consultation room. Once they are trapped, lecture them about drinking.



  • Ask patients if they want some sweets in the consultation room. Once trapped, lecture them about not accepting sweets from strangers.



Nobody Panic


Anybody have a code word or phrase at work to let other staff know that you may have a shoplifter in?


@mrs_commuter: “the windows need cleaning”………


@MykelO: I use “Any black bags in dispensary” Strange but it causes a laugh and works well.


@pharmaste_82: We used to have ‘red book’


@Louise_tweets_: -we’d call ‘Robert’ to the appropriate part of shop. All the staff would flood area, none of which were actually called Robert!


@Cleverestcookie: Reminds me of my father’s in the days of £sd – 2/10 (2 and 10) 2 eyes on 10 fingers!


@dropdboy: we used to have “red pen” until I vaulted over the counter when staff genuinely lost a “red pen”


@Clareylang: well when I worked in community it was code red I mean how obvious is that lol!!


@pillmanuk: GO TO DEFCON 1


@cocksparra: Used to be “pampers” like “is the PAMPERS still on offer?” Now I just say “reprobate” as they don’t know what it means.


@DJ_rai: ‘Does this cost £9.99?’


Aisha Adnan: We used to have only two tills in shop but we would scream” I need help on till number 4 please” and all except pharmacist would come out on shop floor one by one and either keep a Rx in hand,looking for something, other would go pulling stuff forward and pharmacist kept watching CCTV in dispensary..


Simon Butterworth:  No, I just go and stand near the door. Usually does the trick.


@googlybear: Not so much a phrase but a “look”, it kind of says “OMG we have a shoplifter”


Terrah Leigh Taylor: We have a look too. No words, just a crazy look.




Guest Post: Breeds of Pharmacists by Candy Sartan

In over a decade of working in pharmacy I’ve worked with dozens and dozens of pharmacists. Just as David Attenborough lives in the jungles of south America and gets to learn which breed Of lizard or spider is which, I have learned the different types of pharmacist, and can even spot a pharmacist out of their own habitat-the pharmacy. MALE OF THE SPECIES. There are three groups. The briefcase, the rucksack and the carrier bag. these are self explanatory but have specific breed ‘standards’ if you like particular to each type.

Type 1. The briefcase guy.

This type of pharmacist arrives either on time or early, wearing a suit and with clean shoes. He will be in a BMW car of any age but it will be clean. He may come from a multi car household though so if he does show up in a Citroen c2, don’t be fooled, his wife will have had to borrow the Beemer and he will be forced to drive her car. But you will be unaware of this as he will park it four streets away to avoid being spotted.

On opening the leather briefcase there will be a plethora of pharmaceutical gubbins. His own bnf, often with pages marked with highlighter or a post it hanging out to mark where he’s up to. Another tome to be found in the good ole briefcase could be the mep, always a tantalising read over lunch in the consultation room. A common item in this pharmacist’s briefcase is a responsible pharmacist certificate IN COLOUR and perhaps even, yes, laminated. (a far cry from the black and white printable ones on our computer) This pharmacist will bring his own pen. Not just a rep pen or a bic biro. Oh no. We could be looking at a staedler or Parker pen, often in its own case or in a set with a matching mechanical pencil.

Now, the briefcase guy can be any age but the older ‘BG’ will have a well thumbed copy of the mims from as far back as 2003 in case he is checking a nursing home or mds tray. Along with his mims he may carry (and I have seen this) his own pair of plastic tweezers for fishing around in blister packs. this next item never varies. Sandwiches. Wrapped in foil or cling film BG doesn’t mind but he has to have sandwiches for lunch and he has to have had them made that morning and placed into an airtight container for later consumption. He may have a yoghurt (shape is very common as mrs BG does the weekly shop and buys the bumper pack) BG will bring his own spoon. He is a well prepared chap who doesn’t like to chance it that the pharmacy he will be going to will have zero cutlery.

BG will sign in without prompting and have his posh certificate on display before you have got the kettle on. He will have any cd deliveries and supplies written up if not as they go out by the end of his shift. He will help any colleague with training whether it be their OTC training, the technician course or a pre-reg needing some guidance. He will have any information in that briefcase and if not he will have found it in the pharmacy within five minutes.

BG has a tidy diary with colour coded entries and an easy reference filing system of useful information. He knows where he is at any given day and knows distances, opening and closing times of every shop he’s ever worked in.

Lastly the locum claim form. He will have a pressed copy of this in his ‘locum forms’ section and remove it in due course and it will be perfectly filled in and dealt with by the most responsible looking person in that day.

Type 2. The rucksack guy.

This happy go lucky pharmacist will be smart looking but without the constraints of a tie. Perhaps he will be wearing a jumper over just a shirt. Elbow pads will not be out of the question. The footwear is a giveaway of RG. Although I can spot him a mile off I don’t quite understand the temperature requirements RG has with regards to his footwear. He wears socks with sandals. Now, I am not sure whether the sandals are on first, but it’s a little nippy so he puts the socks on to stop the frost or whether the socks are on first, but in case of overheating he just wears sandals. It may even be a fashion statement I admit I’m baffled by this.

Rucksack guy will be just to say on time. He may even fly through the door dead on opening time. No time will be lost though as he has no jacket to remove, no responsible pharmacist sign to unpack and no formalities like shaking hands. You will just know who he is. He has the rucksack.

You may have to ask him to sign in as he is too busy finding the kettle and making himself at home to be bothered with such trifles.

RG will bring his own pen, usually a free rep pen pilfered from the last locum shift or a plain old bic, hell, it may be from the bookies, he isn’t fussy in the pen department (or any other department actually). This pen he arrives with will be left in your pharmacy when he leaves. He’s a fly by night pen collector.

RG has a diary. It is shoved full of bits of paper with phone number and bookings, even expenses receipts. He is slightly disorganised but with a little guidance he will have settled in by lunchtime.

His lunch, incidentally is practically all that is in the rucksack. He will have brought a drink, usually a can of coke (iron bru in Scotland), a packet of crisps, a pre packed sandwich he got at the tesco petrol station on the way in and perhaps some dairylea dunkers. RG isn’t afraid of being in touch with his inner schoolboy, in fact now you come to mention it this could be the hidden meaning behind his style.

He will ask you for a claim form, he won’t have one with him, the only other thing in the rucksack is probably a John Grisham book to read at lunchtime if he gets bored.

Type 3. Carrier bag guy.

Where to start with CBG. We have all worked with one, he is firstly obviously a CBG by his notable absence ten minutes after his shift was due to start.

Not even organised enough to have noted down the phone number of the branch and call to say he’s late you know you’re going to be in for a day of total chaos.

CBG may appear any time after he is expected so be on the lookout. He will breeze through the door past disgruntled patients waiting outside looking daggers and remain oblivious to the awkward conversations we’ve had to have. “but my prescription is only there, I brought it in yesterday. I can practically see it on the shelf” then as if some magic force field has been lifted, people can now be given what was only 6 feet away from them all the time.

CBG could be wearing anything. Usually however whatever he is wearing he will have worn yesterday, and possibly the day before that. His hair will be messy, but not in the stylish “just stepped out of the salon” way, in the “I only got out of bed 20 minutes ago” way.

CBG has brought very little with him. No pen, no lunch, no certificate, no claim form and no diary. He may not even have a diary. I have worked with a CBG who literally had everything he needed to know written on scraps of paper. CBG’s mind is total chaos. He will drive a banger. If you were to look in the car you would find a representation of CBG’s brain. Empty wrappers, old newspapers, maybe the odd hobo that sneaked in there. This is your fly by the seat of your pants kind of pharmacist. Lunchtime comes and he asks directions to the nearest shop, gathers all the loose change from his pockets (probably found on the floor of old betsy the car) and nips out for what he promises will be 10 minutes. 35 minutes later he still has not returned. CBG of course doesn’t wear a watch.

The end of the day approaches and he still hasn’t signed in and there’s a pile of cd scripts and invoices to enter. He probably won’t ask you for a claim form because he forgets, he still hasn’t submitted last months ones yet. Obviously new pharmacists are produced every year from the production line and over the years, what with GM crops and natural selection some variances may occur but these are your three basic types of male pharmacist. No offence is meant to any pharmacist whether he be a straight laced BG or a flighty CBG. These are just my observations over the years. But boy, are they accurate!

Guest Post: The Great Dispenser by @PharmakeusPrime

Oh yes I’m the great dispenser (ooh ooh)
Dispensing to make them all well (ooh ooh)
Their needs are such I dispense so much
I’m lonely but no one can tell

Oh yes I’m the great dispenser (ooh ooh)
The greatest one in this town (ooh ooh)
I heal the lame but in here I remain
Theyve left me to dispense all alone

Too real is this feeling of repetitive stress
Too real but I feel that these medicines will heal

ooh yes I’m the great dispenser (ooh ooh)
Just laughing each day like a clown (ooh ooh)
I study to be an ACT
I’m labelling salbutamols all around
Hoping it will earn me a crown

Yeah ooh hoo
Too real but I feel that these medicines will heal

ooh yes I’m the great dispenser (ooh ooh)
Just laughing each day like a clown (ooh ooh)
I study to be an ACT
I’m labelling salbutamols all around
Hoping that these
Hoping that these medicines will make you well.

Dubious Pharmacy Facts Part 2


51] @MrDispenser: Methadone is also available as a brand called ‘I can’t believe it’s not Methadone’. This has fewer calories

52] @kevfrost: Pharmacies in the jungle constantly run out of aspirin. The parrots eat ’em all. (C) The League of Gentlemen

53] @MrDispenser: The GPs wife is never the practice manager

54] @MrDispenser: Pharmacies love to get phonecalls asking if they are open

55] @The_Buffy_Bot: When we don’t have your medicine in stock we nip down to Boots & get it from them

56] @MrDispenser: Amoxicillin tablets exist and the correct dose is QDS

57] @rmoomin1: The fizzy cocodamol in the foil packets are the only ones that work. Fizzy cocodamol in paper packets are imposters

58] @MrDispenser: I never tweet at work

59] @drgandalf52: there is a secret room where they keep the ‘good’ drugs. Oh wait, that’s true!

60] @MrDispenser: Orlistat was never out of stock. We just think that fat people are more jolly

61] @The_Buffy_Bot: Any uncollected drugs go into a hamper that’s then raffled off at the Christmas party

62] @drgandalf52: There is an elf that steals all the pens attached to wires at a pharmacy desk. He is called P. Atients

63] @aye_sure: Pharmacist’s don’t wait until their CPD is called to write it all up!

64] @drgandalf52: When they run out of inhalers they refil the old ones with Glade plug and fresh. Cures asthma and bad breath

65] @The_Buffy_Bot: When you become a pharmacist you never have to pay a prescription charge ever again

66] @MrDispenser: Doctors never forget to sign a prescription and always check what’s on it before signing

67] @The_Buffy_Bot: GP receptionists are medically trained professionals

68] @weeneldo: Illegal supply of a class A drug? Could do life for it. But I’m not an expert; I’m a pharmacist, not a receptionist.

69] @The_Buffy_Bot: We know exactly which medicines you are taking from the description “It’s a little round white pill”

70] @NavinSewak: OTC medicines are effective

71] @cocksparra: the nurse prescribers have magical scripts.They can prescribe you dressings in ANY size you like, ANY size

72] @NavinSewak: Pharmacies have everything in stock, all the time. It’s their job to do so

73] @NavinSewak: Doctors understand the role of the pharmacist

74] @TheCynicalRPh: Pharmacists understand the role of the pharmacist

75] @The_Buffy_Bot: Pharmacists aren’t really necessary because doctors get prescriptions right every time

76] @thorrungovind: pharmacists know the whole BNF

77] @thorrungovind: you can add a patient on Facebook

78] @nivgill: Surgery receptionists have the greatest clinical knowledge of all healthcare professionals

79] @dthaker: We love asking patient’s if they’re on any other meds for them to initially say no and then say yes 2 warfarin

80] @drgandalf52: Pharmacy is open 9-6. Pharmacy closed at lunch. Lunch time varies between 9.01-5.59.

81] @dthaker06: We know every single colour, shape and marking of every single tablet made

82] @thorrungovind: Patients will make your life easier by coming to the counter when their address is read out, not someone else’s

83] @aisha_adnan: All patients pick up their meds on time

84] @aisha_adnan: There’s never any owings

85] @lmjones06: Generic medicine is actually half the strength of brand name, which is why it doesn’t work as well

86] @Pharm_Thoughts: The best times for flu shots are the first hour we’re open and during rush hour. Never come at any other time.

87] @Pharm_Thoughts: I, the pharmacist, have sole power over the price of medications. I choose the price by reading tea leaves.

88] @Pharm_Thoughts: Drive thru’s at pharmacies were the best idea to have ever come along. I always wanted to work at McDonald’s.

89] @Pharm_Thoughts: Make sure to carry on a phone call loudly while picking up your meds. We don’t have anything important to say anyway.

90] @Pharm_Thoughts: Prescribers and nurses really do know pharmacy law better than pharmacists. Always trust their calls 100% of the time.

91] @Pharm_Thoughts: Drug allergies aren’t important to note in your patient profile. Pharmacists can read your minds anyway.

92] @henrysjl: repeat requests do not need to go to the GP. We just need 48 hrs because we’re lazy

93] @MrDispenser: Drugs not made in the UK are less effective

94] @dthaker06: Bank holidays mean patients need two months’ supply of meds just in case they die in one day’s closure!

95] @MrDispenser: We only dispense fairtrade atorvastatin which does not exploit Ugandan atorvastatin farmers

96] @aptaim: GP receptionists will always expedite your query on an incorrect prescription

97] @jommcmillan: if it’s on the white repeat slip, it was definitely on the green prescription

98] @josh6h: “I only use this occasionally… Honest”

99] @lifeonthepharm: Our delivery drivers use teleportation devices to deliver at specified times, no matter of location, traffic or weather.

100] @KrishOza: It’s not the same unless it’s in an identical box as last time.