88 Comments

I look forward to giving this a good read, but I have to recommend one thing. Aetna was bought in 2018 for $69 billion. How much was paid to CEO of Aetna at that time??? Half a billion dollars! That should be noted.

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From a customer service perspective, CVS is awful. My spouse needed some post-operative medication a few months ago, but unfortunately she needed it on a Sunday. She spent an hour or two on the phone that day calling the local CVS to find out if the prescription was ready, but they never picked up the phone. I ended up going myself and learned that they'd taken the phone off the hook because there were only two pharmacy employees scheduled on Sundays - a pharmacist and a clerk. It strikes me as dangerous and potentially worse that any pharmacy can simply ignore all its phone calls for an entire day, but the staff felt they had no choice because they were completely swamped by in-person customers.

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My husband was a pharmacist at Walgreens for almost 30 years and retired three years earlier than he wanted because the work environment was so horrific. And he hadn't had a raise in six years. I feel for young pharmacists who are stuck. It didn't use to be like this until a big multinational took over and prioritized the bottom line over literally everything else, including patient safety.

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Much needed analysis! And great journalism. Thanks!

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Practiced pharmacy for 38 years with 4 different chains. Never had management support or adequate staff. Constantly overwhelmed. The answer is NATIONAL UNION. And federal mandated staffing levels. Nothing will ever change if left to the number crunchers.

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CVS should be deconstructed..

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To amplify Matt's take on CVS. Yesterday, I went over to the nearest drug store - CVS to get a free flu shot. Sign in the window said free flu shots here. When I asked for my ouchi, they asked for my health insurance. I asked why. Because they bill them for the shot. Okay then, I am retired military so Tricare - nope. I am a disabled veteran with VA health benefits - nope. Medicare? Nope, sorry. I subsequently learned that Publix Grocery honors all three. Do they ever think I will set foot in another CVS? Cancel Culture is free to everybody.

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I work for the aforementioned pharmacy conglomerate, and was the lone pharmacist on for 14 hours the first day we started back with tricare (fun fact, only CVS, Publix, and Kroger take Tricare now). Dante could not have imagined this if he tried and I don't wish the experience on anyone. Well maybe the select individuals who see the suffering of others as a personal inconvenience. That's all I internalize when people complain about the "long wait" or having to "sit on hold" (talk about first world problems?!). I bought a pin for my coat that says "Be a nice human". Remember that as humans on both sides of the counter we are all suffering and on our side literally dying to help you. If you couldn't care less about that then pro tip: I go an unreasonable distance out of my way to help those who exercise empathy and understanding instead of treating my 20 year old technician like something needing to be scraped off a shoe. If you can't do the right thing for the right reason, do it for the wrong reason. Just do it.

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They could also have billed thru "uninsured CoVid injections" since they didnt take Tricare. Hard to think that a major pharmacy chain can't bill Tricare. (Pharmacist since 1982)

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This was a flu shot, not a covid injection, so that billing would not apply. Also, a chain not taking Tricare? That’s not remotely uncommon. It’s happened before and is about to happen again with Walmart.

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What about "sign in the window said free flu shots here" confused you? Oh, and flu shots are injections too.

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First of all, I wasn’t responding to your comment, so I don’t know what point you are trying to make. Secondly, I was referring to the billing of “uninsured CoVid injections.” The reason why that wouldn’t work for flu shots is in the name. This would probably be understood by a pharmacist since 1982, who I was replying to.

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Normally, I would have thought the employee was clueless, but three of them back there all huddled and then in unison say they were sorry.

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Nov 14, 2021Liked by Matt Stoller

I worked at Quidel and can assure you that Stenzel was well compensated with QDEL stock options, which exploded when their Covid diagnostic got approved. Meanwhile, there are quite a few biotechs out there with excellent covid tests and treatments in the pipeline (I’m at one now). FDA delays these approvals severely. Why? Well, we don’t have a Tim Stenzel. And, we have not paid off any FDA officials (via lobbyists).

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A personal story:

Our town had a Rite-Aid store for years. The pharmacy was staffed by two pharmacists and a couple of rotating assistants. The pharmacy was friendly, helpful, efficient. Prescriptions were always correct and ready on time. With two pharmacists, if someone came to get vaccinated, there was still one pharmacist who was keeping up the fulfillment of prescriptions, answering questions, etc.

Walgreens wanted to open a store in our town at a prominent intersection - which was available for lease. But, Walgreens business had to be approved by the planning commission and the borough council. Because the town had the RiteAids store and an independent pharmacy, the commission recommended that the council not approve the addition of another pharmacy - and the council followed suit.

Well, we have a Walgreen's anyway. They bought out the Rite Aid store - and right at the height of the pandemic and before the availability of vaccines.

Because there was one pharmacist there were long lines at pharmacy. Not only was the time to fill a prescription much longer, they often didn't have medicines in stock. We're not talking about exotic cancer drugs. We're talking about things like Omeprazole and Atorvastatin.

I feel sorry now for the staff because customers were complaining bitterly, not only about the pharmacy but the over-the-counter stock as well.

But here's the thing that blew my mind completely: I went to the Walgreen's site to write a complaint about what a bad replacement for our RiteAid store Walgreens had turned out to be and how unhappy many people were. Just as I was about to press the send button on my missive, a notice popped to say that, once I pressed the button, *my comment would become the property of Walgreen's.*

The hell, you say, I thought. (Lord, they monetize everything, don't they.?)

I copied, then deleted my words and went to look for a review site. I found one and put my opinion there.

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I posted about the CVS near me. There was a Rite Aid a block away -- which was bought by Walgreens.

There is still a Rite Aid near me which is fine if I am willing to go without insurance coverage. Fortunately I can get free prescriptions from my employer's in-house pharmacy but most of us don't have that luxury.

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Staffing mandates and doing away with "fill quotas" would go a long way towards making pharmacies safer. Hearing a new pharmacist voice the fear "I'm afraid I'm going to kill someone with a mistake because I'm so tired and overwhelmed with the number of prescriptions I'm REQUIRED to fill" is heartbreaking. My daughter went into this field excited, and now is a broken shell of who she once was.

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I lasted 31 years as a pharmacist but finally retired this year because the working conditions had deteriorated so badly. It was 6 years before I wanted to retire. I wonder how many people in the profession are retiring or quitting like me?

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We would not need all of these pharmacists and their assistants, or at least the workloads would be much lighter, if we only did what the rest of the world does: dispense most drugs prepackaged. The idea that we pay people to literally count pills and put them in containers is simply absurd. Machines can count and package drugs for far less cost and far more accurately. Typically a box of bubble-packed pills is one course of antibiotics or one month of consumption. It is so convenient, fast, and cheap - plus it allows time for the pharmacist to consult, which is where they are most valuable. Counting pills by hand is just another way that the U.S. is falling behind the rest of the world, and to most this just seems normal. We need to get angry.

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Counting the pills is not the problem. If you worked one day in a retail pharmacy, you would see all the other tasks pharmacists and techs have to do, and all at the same time. More and more tasks piled on with less help increases the risk of medication errors. An error in our work can be fatal, so that's the bottom line.

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you might wanna work in a retail pharmacy with these machines before advertising this take. takes humans to fill them up and when they break down... your entire stock is in there. stores with these machines genuinely hate them.

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In the model of other countries, these machines are obsolete. I was educated recently on how the rest of the world does it, and it makes so much sense.

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I was talking about pre-packaged from the manufacturer - the way literally every other country does it. Having a counting machine in the pharmacy is the worst of both worlds, and nothing I would recommend.

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Just what we need, more bubble packs ....

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I don't see that as any worse than the mountain of orange plastic containers I get...

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Oh, I use those containers. They're nifty - can store a small amount of all kinds of things. Nuts & bolts, buttons, stitch counters for knitting . . .

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Amen! - me too! can be re-used, unlike bubble pack which, apparently, can't even be, or, in any case, isn't, recycled - winds up polluting all over and in critters' stomachs - I don't remember seeing a picture of a critter that had eaten a plastic container ...

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Come to think of it, I use the larger pill bottles for bubble pack pills. I hate the bubble pack so much that I dismantle the whole thing in one sitting and put the pills in a used pill bottle. Damn!

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I think the damn things should be outlawed - the bubble packs that is, not the pills, though perhaps some of those should be, too :D

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Mountain? Good grief!

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I agree with you as far as routine prescriptions. For instance, as we age a lot of us, if not all, routinely take some form of statin for cholesterol, and probably something for blood pressure. But my daughter, for instance, has a rather unique set of symptoms for which there is no easy pharmaceutical response. Thus, she has this odd mish-mash of medicines that have to be put together for her.

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Compounding odd prescriptions is one of the skilled jobs that pharmacists would have more time to do if routine prescriptions were prepackaged.

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I agree, but you didn't mention that function in your first comment. The vast majority of people probably have only very ordinary prescriptions and so they really don't know about people with special needs and could think "Well,if they can give us prepackaged medicine, what do we need pharmacists for anyway?"

By the way, my daughter has taken her prescriptions to our Costco pharmacy. They are fully staffed and very helpful.

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My comment was never meant to be comprehensive. I am well aware that in the rest of the world pharmacists are very busy without having to count pills much of the time. They mostly consult with patients who come in, which is the bulk of their time as I have seen (I spent a lot of time in a friend's pharmacy in another country). In a sense we are going that way, by hiring assistants to do the counting and packaging and freeing the pharmacists to do what they have been trained to do. It still makes no sense to hand count - prepackaging is far superior.

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Exactly! Prescribers don't write for most things in standardized way for many legitimate reasons and a few irrational ones. Starting and stopping meds, cross tapering meds, trial of therapy, weight based medication, dosage forms available, etc. As many shortages as we have now, it would be 1000 times worse if each medication had to be in a single patient sized form prior to getting to a pharmacy. Also, we would never be able to partial supply a patient if we had some coming in so that you could start (can't break prepackaged drugs because they are unsellable) and we could never give emergency supplies for the same reason. Medications are used for more "off label" indications than FDA approved ones. No labelled indication means no manufacturer dosing recommendations. Using a cookie cutter approach that leaves a patient with extra pills entirely--and I do mean entirely--defeats the purpose of making it a scheduled (behind the counter) med to begin with. You aren't supposed to have leftovers most of the time.

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Yeah wondered about that myself - over the counter meds come prepackaged why not prescription meds

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Because big pharma doesn’t want to sell 30 tablets. They force stores to buy by the 100,s, 500’s and 1000’s for too many meds. Makes sense for fast movers, but sometimes for less popular meds the pharma company doesn’t care that the pharmacy gets stuck with unused meds. It’s all about market share and money.

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Apparently you think that the only role pharmacists play is that of pill dispensers - an awful lot of training just to count pills ...

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With all due respect, I believe you missed the intent of his comment.

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No, I don't, and I don't see how you came to that conclusion. They are trained to provide guidance to patients, among other things. Counting pills is a horrible waste of their skills.

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Yes, they come prepackaged, I'd be concerned with a giant shipping box of loose skittles. Joking of course, but the stock bottle is honestly more efficient when you really think what you are proposing. We don't have enough room for the 2 weeks worth of filled prescriptions we have at minimum much less the shelves and shelves it would take to hold the packaging for that many patients or potential patients. We do 600 rxs a day easy in that closet space. We'd have to get deliveries multiple times a day. For once it's not just cost cutting. It's not practical. Not to mention restocking that huge volume every day with bottles and boxes that can look identical if you don't pay close attention to the NDC. Of all the pharmacists in retail, I doubt packaging pills breaks a top 10 list. Now counting 800 narcotic pills the size of pin heads twice per person as they stare at you during what is technically 15 minutes before you open is a different story (it's never just one person...or medication). In which case yes. Fentanyl patches for everyone.

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Well you said "We would not need all of these pharmacists and their assistants, ..."

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Pharmacy technicians are not the equivalent of nurses. This statement shows your ignorance of the nursing profession.

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With all so respect, I think this refers to the fact that the techs do so much work and are completely not appreciated. Nurses sometimes are under appreciated. No need to take this any other way. I’m pretty sure that is what that meant to say, although I am not the author.

Of course these are completely different jobs. But the abuse they sometimes take from the public is similar.

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Most of my technicians are indispensable. They do data entry, billing, product dispensing, inventory, cleaning, returns, field phone calls, call on problem prescriptions, send prior auths, call insurance companies, final check at check out, answer questions at the window, drug ordering, deal with difficult patients, restock supplies. Other technicians (none of mine) can administer covid vaccinations. So pharmacy technicians are not merely clerks that ring up your prescriptions. I rely on them in every task that I do

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I could not believe it when I read that statement. Not even remotely close. I appreciate the plight of pharmacy techs, but seriously ridiculous comparison.

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I think a good comparison is there in regards to workload, under appreciation, and stress. It just was not portrayed correctly at all in that article. I don’t believe the article meant to say they were the same. I could be wrong, though.

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Absolutely. I enjoy the company of most pharmacy technicians and they hardly ever advise friends and family to forgo vaccinations based on youtube.

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I am pretty ignorant to this, appreciate your deep dives into things that I don’t think about but should be aware of. Your reporting is detailed and doesn’t feel like you’re trying to get me… just giving me facts. It’s refreshing (and some of it, a little depressing)

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founding

Part of the problem is the power of corporations. Maybe we should be more radical and think about how to make capitalism work without corporations. Associations of persons who all bear individual responsibility for what their association is doing: Yes. Corporations that are persons and have rights: No. Corporations owned by shareholders who are not responsible for the actions of the corporation: No.

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Thanks for sharing these important stories.

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