Sunday, January 15, 2012

Pharmacy phollowup! Joe the Pharmacist Speaks.

Well, we're dipping into the VBB mailbag once again. This time, we have a follow up to our previous post, Pharmacy Phun.

Joe the Pharmacist writes:

Dear Vets,

I found your blog through Dr. Grumpy and have enjoyed it. I am a pharmacist and thought I would write and give you the view from our side of the counter.

Unless pharmacy school has changed since I graduated, there is nothing taught about veterinary medicine. I remember being told that we weren't allowed to substitute generics on vet prescriptions unless specifically told to do so, but that could be state specific. I don't know. I don't really have a clue when it comes to dosing a medication for an animal. I'm going to defer to the vet every time. I might have suggestions occasionally, but not very often. Here are some rebuttals to your post and comments:

The DEA number: I know I don't need it for non-controlled substances. I certainly wouldn't push for it. I will ask for it because I might need it in the future. It is especially helpful to have if you get a CS prescription handed to you or on voice mail that doesn't include the DEA. You may always remember to give it, but your agent calling it in might not and some of your MD counterparts suck at it. I can't even count how many times of gotten a CS prescription from Big Teaching Hospital in different city from doctor I've never heard of, with no DEA number. Also, you called me, a licensed professional with a degree, I didn't call you out of the blue demanding your DEA number.

Amoxicillin isn't labeled 25mg/ml. I know 125mg/5ml is the same but sometimes brain farts happen. We're so used to seeing it prescribed one way that we want to be sure we are doing what you want. However, it would only take one phone call for me to realize what you mean and I wouldn't bother you any more.

For a long time, the only way to get hydrocodone was in combination with acetaminophen. There are various acetaminophen strengths and now you can get it with ibuprofen as well. As of this writing, you still cannot get hydrocodone as a single ingredient product. Pharmacist should have called to verify, but I could also argue vet should have known as well. [NB: there is a product called Tussigon, which is hydrocodone/homatropine, which is typically prescribed by vets - that's probably what the original vet was hoping to get. Anyway. Not that important right now... -VBB]

We are very limited to what we can substitute for humans, much less animals. If the doctor prescribes amoxicillin, I can't just give cephalexin instead. Pharmacists doing that could get into some real trouble.

As far as pharmacies dispensing vet products, just wait until Wal-Mart jumps on the band wagon and starts offering them for four dollars.

One of your vets mentioned she should have gone into pharmacy instead. Don't be disillusioned. I find a remarkably similar theme to your vet blog and some pharmacy blogs. Large school loan debts, lack of respect from patients and big chains stealing business away with low prices and poor service. Add poor reimbursement by third party plans and insurance card problems and you have my job.

Thanks for the compliment about our expertise in medications. I'm sorry your colleague has had such poor interactions with other pharmacists. Love the blog. To see the idiocy that we deal with, check out Drug Monkey, The Angry Pharmacist, Pharmacy Chick and the many other pharmacy blogs. I don't have a blog. Maybe soon. For now, you can sign me as: 

Joe Pharmacist

Joe, we thank you for your words of wisdom, and look forward to that blog you're promising to start any day now!


  1. Joe Pharmacist, you sound like my kind of pharmacist! Thank you for reminding us that everyone tries their best. I realize that I, the veterinarian, am probably twice as annoying to the pharmacist I deal with than they are to me. I get to blog about it though, tee hee hee.

    Walmart has already struck. They are proposing bill HR 1406 which will require that we write scripts for everything. In their thinking, once we script out all medications, they can be there to fill the scripts and get richer. As you pointed out, pharmacists are not taught veterinary pharmacy, and my experience with my local Walmart pharmacist has been dismal. I have thought about recording some of our interactions here but it is so bad, suffice it to say, I have reported him to the Board of Pharmacy more than once. Our state doesn't care--they are just dogs and cats (and birds, reptiles and rodents). I have gotten so fed up with the annoyance to my clients, that I have priced a number of frequently used medications at cost. This is a terrible business plan but the price I am willing to pay not to be verbally abused and my client disrespected. I tell people not to go to Walmart. $4 are one thing, but the $500 to fix the mix up is another.

    Thank you so much for your input--it is fair discussion that usually results in the truth.

    PS I LOVE Drug Monkey.

  2. First, a bit of back history. I work emergency full time. 'Nough said.

    Second, both my parents and my brother are pharmacists.

    Third, my interaction with pharmacists have been abysmal. Especially with the closest 24 hour Walgreens less than a mile up the road. My favorite is that in Arizona and Florida, Walgreens uses a call center. So when I dial the phone number that should connect me directly to the pharmacy (again, less than a mile up the road), I get connected to a random person in the middle of nowhere to talk about my prescription. When I speak to the pharmacist, they are even less helpful.

    I favorite experience was when I had 7 (yes SEVEN) parvo puppies that were from the same litter that were hospitalized. No expense spared. I started them on Tamiflu (yes, I know the research doesn't back up its usefulness, but in my experience it helps...doesn't hurt...and if they are will to try I go for it). I call in the prescription, I am told it will be ready in 45 min. I send a tech up to the pharmacy 1.5 hours later...and its not read. OH, and they don't have it in stock. *Cue explosion inside my head*

    This has happened more than once.

    I call to complain to took 4 weeks for them to get back to me. And it has happened more than once after that. I hate corporations. I am small business all the way. Sadly, I just need to find a small business pharmacist that will be on call for prescriptions after hours.

    Joe Pharmacist...Publix has free prescriptions, Walmart has $4 prescriptions. I don't offer those anymore since it's not worth the headache!

    Long story short, emergency medicine is awesome. I love it.

    This blog is fantastic.

  3. Thanks for the post Dr. Joe! I admire you guys. Keep up the good work.

  4. Thanks Joe!!! I know you aren't all morons, just like any group. It's just frustrating. I do really appreciate our local Target pharmacist who works with us, asks questions and seems genuinely interested in being there to help us. I will admit, I don't know all the fancy schmancy names for drugs. When I call in a "triple antibiotic eye ointment without steroid" I rely on you to know and tell me what's in it so I can say yay or nay for my patient. I know it's probably really annoying when I have to call you at 4p-6p with questions like that when you're probably slammed with rx pick-ups and I appreciate when you take the time to A) answer the phone and B) go through info on three different medications before I choose one. Those times, I'm sure, you're as frustrated with me as I have been with others in the past. Apparently, our lives suck equally. :)

  5. Thanks for the perspective Joe. I hope our pharmacist friends will consider joining vets in calling and writing our representatives in protest to HR 1406 Fairness to Pet Owner's Act.

    If such legislation is passed, I hope for both vets and pharmacists sakes that pharmacy professional organizations create some veterinary specific CE to minimize confusion and mistakes.

  6. Hi, I'm pharmacist from Indonesia, permite me to read this blog, to got some knowledge.

    salam umaee :D
    my blog too,