Pharmacist here. It’s not our fault as much as you think. Basically, the insurance companies invented something called “Pharmacy Benefits Managers” who basically act as a middleman between you and your doctor on what you can get, and how much they will reimburse the pharmacy if you do.
If your doctor says you need atorvastatin, but your PBM says they only want to pay for simvastatin, you can either get your doctor to pay for simvastatin, or pay for atorvastatin yourself with a discount card. The cost for a generic med like that is probably about your copay anyways, so no big loss to you to skip the headache.
Surprisingly, they invented fees for pharmacies! If you choose the route to get your doctor to change you to simvastatin, we get the privilege of managing that for you, and once we finally reach your doctor and make the change, they will give us maybe $10 to fill it for you! Plus you have a $10 copay, so there is some money… But of course we have to source the med. It probably costs us like $12 for this example, maybe less maybe more, depending on the manufacturer. So if we do all of this then it seems like we made $8, but SURPRISE, your PBM charged us a fee for utilizing them. It might be $6. It might be more if we don’t meet certain criteria, like percentage of diabetic patients on statins.
So okay we have our nice $2 to pay for shipping your med to the oharmacy, renting our location, and filling it (I think it’s less than half that on average, I just don’t know the actual figures) with our staff. It should come as no surprise that we have very limited options on manufacturers now.
You might say “well at least the PBM fought to make my meds cheaper in the end” but no! They now get to say to your insurance company “okay we managed getting your patient another month of lower cholesterol, please pay us $100 for our efforts”. So, indirectly, you paid an extra $100 on this whole thing through your insurance premiums. Not sure on if this part is true I just heard it as a rumor.
But wait there’s more! The insurance company actually owns the PBM all along! They paid themselves to offer themselves this service for you!
So anyways I’m getting out of retail pharmacy. Thanks for coming to my ted talk.
I didn’t need to get this upset before 8am. I don’t even take medications, but this is the exact type of nonsense that gets my blood boiling. That there’s anyone between a patient and their doctor (or perhaps a patient and a pharmacist) is just screaming for some forced changes.
Anyone have that I’m too European for this image handy?
I am too Indian for this, even though we have a strange habit of copying the shitty parts of the US and ditching the actually functioning parts.
America: Land of the Free, Home of the decreasing average lifespan because people can’t get access to routine medications that are affordable in most other countries.
the thing that annoys me is they don’t care that you have a chronic condition. it’s not going to change. i’m going to need this med for the rest of my life.
but they need my doctor to re-up the prescription every 6 months all the same
They do care if you have a chronic condition. If you do, they can charge you as much as they want.
This is because the doctor is supposed to be monitoring the condition and adjusting to a better med if one exists.
Oh, is Walgreen’s your pharmacy too?
You forgot the pharmacist who thinks they know more than your doctor and has the gall to opine on your prescription.
Dude.
MDs fuck up prescriptions all the time. You want this.
Yeah pharmacists often know a lot more about drugs than doctors, and they get to focus their whole career on getting good at just that
But thats like their main point. Pharmacist do know a lot about drugs. It’s important to know about negative drug interactions and a pharmacist is more likely to catch it since they most likely know all the drugs you are taking. Your GP might not know about the drugs your psychiatrist gave you or that off-label drug your dermatologist gave you because people are horrible at knowing what drugs they are on and for what purpose.
Fair enough. All I really mean is “idgaf some random pharmacist is opposed to stimulants.”
Honestly I’ve always been surprised how much education is required to be a pharmacist when all they do is put pills into a bottle (obeying whatever the doctor wrote on your prescription) and pass it to you through the window. Then imagine going through all the years of University to get a master’s degree to work in the back of a CVS.
Seriously? They source the drugs, in the correct dosage, or they have to compound a drug, they have to know what other drugs you are on for conflicts that could kill you. They also teach you how to take the drugs correctly.
Why do people who have no fucking clue make comments?
As an outsider to the field it seems ridiculuous that being a doctor does not include this bit of knowledge. If a pharmacist is expected to do all this and able to override an MD (who can get the prescription wrong)… seems like a circus to me.
A pharmacist is much more qualified to give you that information than a fucking Doctor. The pharmacist instructions are for the exact drug in you hand, when you get the drug.
There are a lot of bad prescriptions to be honest. The amount of people who are prescribed both Adderall and large fills of benzos is too damn high.
don’t forget all those opiods the MDs told us were non-addictive.
That was a shame. Because now we have gone the opposite direction and they are massively under prescribed to who need it.
They aren’t even that addictive. Look up addiction rates for people prescribed them legitimately. But saying they were non addictive is obviously fucked up… Pharma reps were literally gaslighting doctors into thinking that they just weren’t prescribing enough and that’s why their patients were having pain, after 12 hours. Definitely not withdrawal symptoms
And the pharmacists helped that… How? Exactly?
Doctor: for condition A use med B in C manner.
Pharmacist: Oh no, what is he nuts? Never use med B for condition A as it contains flixadidlian cortemolezeum which will react badly to manner C. No you’ll need med D.
i mean occasionally the pharmacist is right.
Yeah that’s the pharmacist’s job
yeah, now most of the time the pharmacist is too busy to actually do their job. what people get angry about is when they do it.
Oh I’m glad when they do it. But I also find it a little concerning that your doctor is supposed to be the one who knows everything and then it turns out they sometimes seem to talking out if their ass (or that’s what it looks like at the very least, I’m sure there’s more nuance to it).
sometimes it’s frustrating when the pharmacist is rechecking your work and insisting that the interactions (that you have verified are not a problem via taking the drug for twenty years) are going to be a problem if you accidentally take the drug once. occasionally the patient does know more.
They learned from all of the mechanics, plumbers, construction crews and electricians. While most of the rest of the world goes broke these folks will do okay. I once called a company to look at a window that needed replacing and the first thing he said when he walked up is “Your shingles are starting to curl”. I went with another company who was more reputable, charged me fairly, and did good work. It’s tough out there.
But are you sure your shingles aren’t starting to curl? Maybe the other one just didn’t have a shingles guy so they don’t give a fuck about your curled shingles
Clearly he put a curling iron to his shingles for that fancy curled shingle look. Why would he want that fixed?
Blaming pharmacists for things they have no control over, nice. Biggest brain
The worst is the old people in front of you arguing with them as if they have any ability to do anything. And taking 20 minutes to pick up one medication.
fun fact its usually the pharmacy tech that deals with all the bullshit with insurance, the pharamcists rarely do it, they just determine the correct dosage, medicaiton.
Every refill feels like a side quest with surprise fees and a boss fight at the counter.
Another meme I cannot relate to because I have the privilege of not living in america
Haha was thinking the same thing. Minor issues here for certain medication availabilities at times but nothing that would make this meme relatable to many people!
Yup. In the uk, you pay the same charge for each prescription you pick up, whatever it is (or you get an annual flat fee pass if you get more than one a month). So if the pharmacy only found an expensive version, that’s a them problem, not a me problem.
Americans just don’t get that brand name medications are exactly the same as generic ones either 😅
With prescriptions, it is not about what the customer wants, it is about what brands the insurance wants to cover (and getting a doctor that does not write a brand specific prescription). If an insurance company only covers a weird brand of a common (but expensive) medicine, the customer either has to hunt for a pharmacy that has it in stock, wait for their local pharmacy to order it (in either case delaying when the insurance company has to pay for it), or buy the in-stock brand without any insurance coverage. The insurance can still claim they cover the drug while paying less for it.
At one point, I was on a medicine that had a very high co-pay for the brand name and would not cover the generic. It was so high that it was cheaper for me to buy the generic uninsured instead of paying the co-pay.
The active ingredients are exactly the same. The inactive ingredients may differ and there may be some slight differences in bioavailability that for most people are not significant. There is no reason that the vast majority of people can’t take a generic equivalent of a branded medication. That said, there are sometimes exceptions that need to be considered on a cases-by-case basis. Anyone who says “I can’t take generic medications” is full of shit.
Source: I am a licensed pharmacist.
There is no reason that the vast majority of people can’t take a generic equivalent
There’s no reason why ANYONE can’t take generics. Over here (UK) its extremely unusual to be prescribed a brand. And we’re all absolutely fine.
The difference? Pharmas can’t advertise their products to the general public. Nobody falls for the marketing guff and nobody makes up reasons to need branded medication.
My daughter has an anaphylactic reaction to an inactive ingredient that is present in some generic products but not others. We have to be very aware of what company makes the generics she takes to make sure exactly what they contain. That’s why I say most people can take them and not everyone. Some medications will harm her more than help because of an inactive ingredient.
Surely thats a problem with ALL medications then? Not just generics?
Possibly. There are branded products that she is allergic to and she’s not allergic to the generic, but it tends to be the generics using the ingredient she can’t have.
My point is that the generalizations are MOSTLY true, but there can be exceptions. People who discount all generics out of hand are usually just blowhards.
Ok…but generics are not always compounded for delivery like the original brand, I.e. slow release, enteric coatings, dose size, different fillers.
But a licensed pharmacist should know that.
I don’t know if you are in the US, but AB-rated generic equivalents are determined to have a release profile that is within an acceptable range of variance from the reference product to still be considered equivalent. I’m not saying that all diltiazem products are equivalent because obviously Cardizem injection is not the same as Cardizem CD is not the same as Cardizem LA is not the same as Cardizem regular tablet. What I’m saying is that Cardizem CD 240 mg capsules and all of the AB rated equivalents a pharmacy would substitute for it may have some subtle differences, but in general they don’t matter clinically for patients.
The fun part is the generics aren’t always the exact same medication! In most cases it is a 1:1 between name brand and generic but there’s always edgecases, whether due to allergies or quality control or sometimes the recipe differences actually impact the potence and performance of the medication
Not all of them are though my wife can only take the name brand of cimbalta because the generic fucks with her body
Pharmacists deal with drug shortages worldwide.
Yeah, my pharmacy texts me to confirm I want a refill, then I go pick it up. One extra confirmation text and wait a couple days if there are no more refills
To be fair, this is generally my experience in the US as well. However, I do recognize that the insurance I get through my union is very good.
I live in America take boat loads of meds cause I’m post transplant and don’t have these issues, I think OP needs a new pharmacy
RFK Jr.: You need meds? What’re you gay?
he just dips in methyelene blue, suntans till his skin is more burnt than a rotisserie chicken and hopped on roids at 70. fun fact the bear incident was just 11years prior.
Nothing a few hours on a tanning bed won’t fix.
PrFK Jr
