JP spins a semi-fictional account of what is wrong with chain drug stores and mail order prescriptions.
“This is a pharmacy, isn’t it?” How many times have you heard that? Or, even more hackles-raising, “Well, you are a pharmacist, aren’t you?”
How many times have you wanted to reach over the counter with your feminine right hand and give Ms. Pompous and her supercilious smirk a good slap? “Yes, I am the pharmacist and I am a doctor. You will call me Dr. Patel from now on or you get another slap.” You stab at her with your right forefinger. “I am an American and if I go back where I came from it will be with my American husband named Perkins and my American son to see my mom and dad in the west suburbs of Chicago to celebrate Christmas.”
That felt good, but it would not be helpful. How do you turn around and double-slap Ms. Pompous when she demands a $5 copay for an antibiotic prescription?
“I have Bazooka Excellent-Level Prescription Insurance powered by Out-to-Pasture Citizens Association. My copay is not $20,” she insists.
What you want to say is: “You have Bazooka Chicken-Level Insurance powered by Insurance Pimp Association.”
With a smile and a sugary tone, you say: “Bazooka is spelled M-A-I-L O-R-D-E-R, Ms. Pompous. You can get 30 days right here at your neighborhood drug store just a block from your house with a half hour wait, or you can get 90 days for $5 from the Real Supply Dispensary that is owned and operated by Bazooka in a warehouse in the Sonora Desert 3,000 miles from your home, with a wait of at least 10 days. If you want this prescription before 10 o’clock this morning, it will cost you 20 bucks.”
“I hate mail order,” she argues. “I told you I have Bazooka Excellent-Lev…,” Ms. Pompous throws her forearm over her face. “Please Doctor Paddle, don’t be mean to me. I’m just an old lady who needs her medicine.”
“Oh for gawd’s sake, you are barely 65 years old. That is the new 45. You bought crappy insurance,” you respond.
“But it is excellent-level,” she says again. She is arguing with you now, as if that would make you give her a $5 copay.”
“Excellent is their lowest level. Platinum is Bazooka’s best.”
Oh oh, the non-pharmacist store idiot is watching you. The next thing you know she will hand Ms. Pompous a $50 gift card to make her happy. Big Stupid Drug Store with a share price of less than what they charge for a 20-ounce diet cola has been throwing money as the solution to everything for over a decade.
The gift card changes hands. Ms. Pompous hands over the antibiotic prescription. She grins, “You said 10 minutes?”
“More like 45 now. There are three more people ahead of you,” you say. The store idiot is about to say something, but you stare her down. She can give away the store if she wants, as long as Big Stupid never misses a payroll. She needs to keep her nose out of the pharmacy. That is your domain.
Ms. Pompous is now your friend. “Can’t I get my eye drops from you? They are supposed to stay refrigerated.”
Your staff pharmacist is a strapping young man from farming country. You don’t want to get slapped by him. He has been listening. He holds up a box. Latanoprost ophthalmic solution by Greenstone, a progenitor of that venerable brand Upjohn. Is Dr. William rolling over in his grave?
“That’s it. That’s my refrigerated eye drop.”
The staff pharmacist hands it to her, “Read it and weep,” he drawls. “Read under the red letters.”
During shipment to the patient, the bottle may be maintained at temperatures up to 40° C (104° F) for a period not exceeding 8 days.
Why do we have to refrigerate this stuff at all? Talk about pimping. This is brazen pandering to the mail-order outfits. Greenstone has the nerve to print on the back panel: Store unopened bottle under refrigeration at 2° to 8° C (35° to 46° F).
I didn’t know that the USP has changed the storage standard of no higher than 78° F. I think that you will find that most states define drugs stored at temperatures exceeding 78° F as adulterated. What about pills sitting in a mail box in July over the weekend in south Texas? Are the state three monkey board$ ignoring patient safety? Let them conduct a meeting in a closed, parked mail truck in the sun.
Jim Plagakisis a community pharmacist in Galveston, Texas. You can e-mail him at firstname.lastname@example.org and cc us at email@example.com. You can also check out his website at jimplagakis.com.