Take Some Aricept (Sorry Donepezil)

What the Hell !!! Sorry to post so soon but Mr. Mayer has made me just a little mad.(Drug Topics Final Word February 2012)  How dare he suggest Walgreen's CEO get the Remington medal.  Has he lost his freaking mind!  Let's review.
Walgreen's takes a stand on ESI because they are not paying them enough money.  They don't pay the rest of us enough money.  I would love to tell ESI to kiss my butt but I don't have wall street giving me butt loads of cash to keep my store open, nor do I have crap from China on my shelf to sell to my customers at 300% percent profit to help keep my doors open.  Did I forget to mention that I get about 5% percent of sales off my front end while Walgreen's gets about 70%.  Hey Mr. Mayer, did you forget how Walgreen's got it's growth spurt?  See one of my first articles about prohibition.
Let's look at your earlier statement in your article shall we. Quote "in 1962, when I opened my pharmacy in Sausalito, Calif., there were 59 independent pharmacies that took care of Marin County, Calif., patients. Now there are 4 independent pharmacies left, partially due to the 3 managed care companies like ESI, who have squeezed the small businesses out of existence."  Well Mr. Mayer, how many FREAKING WALGREEN'S and CVS's are in MARIN COUNTY !!! Get real... These guys (chain pharmacies) have advantages over all independents.  It's called WALL STREET INVESTORS.  I would love to have people give me free money.  (Mr. Mayer doesn't even mention what chains have done to independents over the years and their mail order facilities).  Did he mention that Walgreen's has doubled their efforts to expand their mail order facilities and their central fill facilities? no? well la tee da... do some research...if you really are president of a consumer advocacy group do some advocating for a change instead of just placating....
Now for some sobering stuff...
If Walgreen's stock suffers...from NOT taking ESI, or from ESI refusing to allow Walgreen's to participate (can you say Rx Ally anyone) then you will see the board of Walgreen's replace management very rapidly.  It happens everyday.  That is Wall Street reality. 
So Mr. Mayer, I agree with you that pharmacists should do what that are trained to do AND get paid for it.  HOWEVER ( I know I am shouting, it's the best way to be heard) being stupid and praising Walgreen's isn't the proper way to do it. Just calling the kettle black.
Kris

What PBMs Do

Kudos to Mr. Evan Vickers! Mr. Vickers is a member of the Utah House of Representatives and a pharmacist.  In the February edition of Drug Store News he tells it like it is.  PBMs provide almost no value to our economy, no value to health care and almost no value to the consumer.  I will quote a few memorable passages "PBMs profit at the expense of consumers. These are for-profit companies that function as intermediaries between health plans,drug companies, retail pharmacies and patients.  Their motive is PROFIT, NOT PATIENT CARE. The three largest PBMs, including ESI and Medco, have seen their profits nearly quadruple in the last three years-from $900 MILLION to more than $3.5 BILLION- while most Americans have struggled through a tough recession."
Doesn't this just make you sick to your stomach.  If you are involved in health care at the provider level at all, you have to be sick to think of how much money is being wasted on corporate fat cats.  McKessions CEOs salary equated to about 25 thousand dollars for each independent pharmacy that does business with them.  Isn't that a kick in the pants.  As small business people we are constantly being asked to help our local communities and our patients (who are unemployed and broke).  We are being asked for more and more dollars from our associations and co-ops to fund activities to fight these abuses.  I don't have a problem with this as long as there is accountability and transparency.  We need to make sure our leaders are transparent and accountable just like we want the PBMs to be.  I will give you 50 bucks to give to a congressman but you had better make sure he votes for our bills.  We need to make sure that people whom we give money vote to help independent pharmacy. 
On another note, Dr. Dan Hussar, from the Pharmacist Activist, wrote that CVS should have criminal charges filed against them for their activities involving oxycodone in Florida.  CVS obtained an injunction to prevent the DEA from shuttering two of their stores in Florida that dispensed many many scripts of oxycodone while two independents were closed.  Thanks Dan for exposing what CVS is doing and also Cardinal.  Wholesalers are also not exempt from that almighty dollar.    Don't get me wrong, if you are breaking the law, you need to go to jail.  That means independent, CVS and yes, Cardinal.  Maybe it's time the CEO of CVS and Cardinal were dragged out of their penthouses in handcuffs for allowing their locations to break the law over and over again.  I know that I would be on the 6 o'clock news being put in the squad car if it was my store.  Why not them? Oh, that's right, money...
Hey, you guys heard any more about RxAlly?  No, read the first paragraph again and substitute RxAlly for PBM and see if it makes sense.
Lastly, thanks to the brave independents in North Carolina.  You guys are our heros!! For those of you who haven't heard, there are four independents in North Carolina who are suing CMS for allowing restricted networks and differential co pays.  I wish you the best of luck and we need to support them with our dollars.  This is what matters.  Get your co-op and association to get behind them and support them.  It is about time someone stood up for what is right.  Thank you !!!!
Til next time.
Kris

Bulls in Texas and The Beatles

This week in Florida there was a man named Loeffler from a big company called HEB that made a bold statement.  He said and I quote "In Texas they say that if it looks like bull crap, and it feels like bull crap, and it smells like bull crap, then it probably is genuine grade A pure bull crap".  Kudos to Mr. Loeffler for making that statement about the ExpressScrips/Medco merger.  He also said that Medco chairman and CEO David Snow is in line for a 39 million golden parachute. Quote "now who does it look like has been using the lack of transparency to shovel big money their own way as opposed to driving health care costs lower?"  BTW Mr. Loeffler is chairman of NACDS.  Pretty bold.  Thanks Mr. Loeffler for calling that particular kettle black.
On another note this week I received a nice fax from my friendly pharmacy co-op asking me to join the "revolution" (yes, using lots of quotation marks today).  What's this you say.  The new RxAlly revolution.  There was a link so I proceeded to watch a 45 minute press conference and I must say at the end of presentation I was just as confused as in the beginning. Here's the skinny. The RxAlly CEO is Bruce Roberts.  Remember him, former NCPA CEO who took credit for starting such things as SureScripts and Mirixa.  Well he's back and has partnered up with our dear neighbor down the street; Walgreens.  RxAlly is a for-profit company that not only has Walgreens as an owner but our very own co-ops.  See if you recognize yours: Academy of Independent Pharmacy of Georgia (AIP), American Associated Pharmacies (AAP), American Pharmacies (APRx), American Pharmacy Cooperative, Inc. (APCI), Carolina Allied Pharmaceutical Services (CAPS), Chain Drug Consortium (CDC-lots of non stock market chains), EPIC pharmacies (EPIC), Independent Pharmacy Cooperative (IPC), PBA health (PBA), and Pharmacy Providers of Oklahoma (PPOK).  Whew, what a mouthful.  Let's discuss this new alliance.
RxAlly claims to have 20 thousand member stores.  In reality they have the CEO's of the various groups and their boards.  NOT their members.  I understand per RxAlly's website that each store must sign up (or was it each pharmacist?) so that tells me they have nothing in the way of a network so far.  I understand the concept but let's be transparent here. What is the purpose of RxAlly? Wait, here it is. Quote "Help patients achieve better health through personalized pharmacist care while reducing costs."  Great concept..Why did RxAlly go with pharmacy buying groups as partners in order to provide these services.  You would think they would have gone with more professional groups say like: APhA (American Pharmacists Association), NCPA (National Community Pharmacist's Association), ASHP (American Society of Hospital Pharmacists), ACA (American Colleges of Apothecaries), AACP (American Colleges of Pharmacy) or NASPA (National Association of State Pharmacy Associations).  I didn't see any of these folks during the press conference.  All I heard was the 280 billion dollar waste (and the 20 year old Ashville study) and how PHARMACISTS could help lower this cost to EMPLOYERS... How does a co-op or Walgreens (who are profit driven) even begin to be above board in bringing savings to patients.  Greg Wasson, CEO of Walgreens said it was about the PROFESSION of pharmacy and changing the landscape.  Ok, cool, but why do you need a drugstore for that change?  Why couldn't pharmacist's provide that service from home or on their off days?  I wonder how many people involved in this start up has EVER provided a clinical service.  It looked to me that there were a bunch of white headed CEO's in the room who I bet haven't worked the pharmacy counter since Nixon was president.  One thing I didn't hear a lot about during the press conference was how pharmacy was going to be paid for performing these services.  Still a mystery.  I wonder how many pharmacists will make up the board for RxAlly?  I bet there will be a few but probably most will be CEO's and MBA's.  There may not be a single independent pharmacy owner on that board. (I bet not).  Just a ramble or two more.
It seems to me that Walgreen's (being shut out of ESI and soon Medco) is looking for a way to shore up it's losses so that big Wall Street investors will continue to funnel money to them.(they just bought BioScripts, a big mail order speciality pharmacy)  They have a great game plan.  Let's look at how independent pharmacy survives and copy that! (and still keep our mail order and central fill facilities and our buying power) Wow, and now let's form a company so we can learn from them first hand; (remember who Bruce Robert's used to work for?) and to get their buying groups on board as well.(why didn't the co-ops do this on their own, who needs Walgreens) This being said I would ask Mr. Wasson why the rest of the profession wasn't at the table?  If it's about moving the profession then let's get the profession to embrace change.  The RxAlly model is not new (maybe the Walgreen's part). Independent pharmacy has been taking care of patient needs forever. That's why most pharmacist's want to own their own store. So they can practice how THEY want and take care of folks how they want.  Not how some MBA CEO tells them. Bruce Roberts says that "There is a need for greater access to health care for patients throughout the U.S." All patent's have access, just not everyone is willing to pay. Everyone wants lower cost but no one wants to pay for it.  It also makes me mad as HE double hockey sticks that EVERYONE skirts the real reason we have such high health care costs in America.  WE Subsidize the world!!  If we paid for our drugs like other countries we could reduce pharmacy costs by billions. (and even pay our pharmacies more).  If we regulated the manufacturers and middlemen (PBM's, TPA's etc) and taxed them appropriately we could save billions more.  Our system is set up for making a few people rich (1%) and the rest of us paying the price(99%).  We have multi billion dollar companies running rampant over small business and a congress that holds out it's hand and looks the other way. Tell us what you want us to hear and put that money in your pocket. I hope RxAlly achieves it's goal, but I will tell you I am sick and tired of working for free.  I hate to think that a middleman (RxAlly) is going to negotiate with payers for my services and then tie my performance to a contract.  When I perform a service for my patients they pay my price  (outside of filling a prescription) and they are usually very happy with the outcome (everyone wins).  I think that since about 100 percent of our prescriptions are dictated by PBM's, that other entities see pharmacist services as an area they can exploit (and make themselves rich in the process).  You know this model has worked before.  Are your Surescripts transactions free yet?  Let me now quote the Beatles.
"You say you want a revolution, well you know, we'd all want to see the plan.  You ask me for a contribution, well you know, we're all doing what we can.  But if you want money for people with minds that hate, all I can tell you is brother you'll have to wait. Don't you know it's gonna be alright."
More on this subject later.  I've got to clean out this stall.  You know they have bull's in all 50 states.
Kris

The Amazing Spiderman and Fails To Care

Well, another year, another crappy start with insurance/PBM issues.  How many new cards have you had to call about, and what about that D.0.  It should have been called BO or better yet BS data requirements.  I hope everyone had great holidays and enjoyed the seasons and now let's get to the new year.  We all know the story of Peter Parker, the boy who was bitten by that spider, and overnight received amazing powers.  In our independent industry today Spiderman is the Co-op.  When co-ops first started out they were going to help us in purchasing generic drugs.  Now they do everything from third party contracting, front end merchandising, loss prevention, auditing help and who knows what else.  During this whole process where are we at with purchasing generics? Not much better than 20 years ago.  None of our independent co-ops are big enough to leverage any generic company so most of them use one of our friendly neighborhood wholesalers to get the leverage.  Nothing beats being the little guy with a 300lb defensive lineman behind you. When we fill scripts and get paid 8 bucks for 8 ounces of Hydromet from Caremark and that 8 ounces cost us 22 bucks where did our co-op benefit us?  I say that every service a co-op provides benefit independent pharmacy, but someone needs to hammer these companies to get the lowest price on generic product.  IF our co-ops are amazing (and most are) then why in the hell are they not working TOGETHER !  If every co-op joined together and put together a program to bid out generic product then we could get somewhere on the buy side.  To do that, guess what, they need to get rid of the 300lb lineman, and that ain't easy.  Especially when he helps you do all that other amazing stuff.  I think it's about time our friends in the co-ops start working for US and find a way to work together to lower our costs of goods.  Now let me say this.  I hear that there is movement under foot for some of our co-ops to work with some of the big boy chains.  If this happens I would ask, do you think that the big boys will give up their advantage to help us? Maybe so. All I know is I would rather have all the independent co-ops working together than a few working with one of the big chains.  As for Fails To Care, don't you think the FTC is about as useless as a pig with wings.  How in the world can they fail to see what harm this alliance has done to the public by the way they are restricting access and taking unfair market advantage of patient data.  Now that this has been decided by the FTC you will see more restricted networks and use of patient data than ever before.  I guess when every last independent pharmacy is closed maybe the feds will care.  CVS/CM paid 5 million, I bet NCPA and other independent pharmacy groups spent over 50 million fighting this merger.  So, what about ESI/Medco?  I say, save your money.  Fails To Care will approve it as well because the FTC could give a rat's whisker about small business.  They never have and never will.  If the republican candidates want to do away with a part of government that is worthless for small business then let's nominate the FTC.  Listen, let your voice be heard.  If you are tired of all this BS, let your co-op know, your association know, your congressman, even your mailman.  If you don't like the way an audit turned out, go to the courthouse and sue them.  Ask a jury of your peers if it's fair for a PBM to take back the cost of the drug when there are no laws broken.  Stand up, get angry, make some noise.  You don't need that lineman.  If every Peter Parker stands together no one can stop them.  Start standing.
Kris

Twas the Day Before

It was the day before Christmas in the store and normally we are running around like headless chickens. Today, however was different. Very few folks in shopping. I guess they are crowding the grocery stores and big boxes for that last minute discounted stuff that we all seem to give each year. I remember past Christmas's when we were lucky to get a gift. Most of our fun came from playing with cousins we hadn't seen in a long time, or showing off the one present we really wanted or eating food that we only got at Christmas. I know I am not talking much pharmacy today but I think that what is happening to us in pharmacy is just part of a bigger problem we have in our county. We have forgotten how to be compassionate and giving. We want instant reward, not reward from hard work and dedication. I was talking to a friend of mine who works for the 3 letter pharmacy company and she was telling me that they were gearing up for all those Express Scripts customers to arrive in their stores. She was filling up gift bags to give to those switchers to thank them for choosing them. Something for nothing. Customers, patients, friends, whatever you call them, have forgotten the night you came back to the pharmacy to get medicine for their sick child 10 years ago, or that time you went out of your way to get a certain drug for them. They are loyal now to the card. If the card says go to xyz and you get something for free then off we go for the discount or free stuff. They remember us only when they are told no at xyz. I had a doc's wife call today who wanted us to order some brand Sudafed PE (yep) and she hasn't had a script filled here in 6 months. I know she only called us because her xyz didn't have it or wouldn't order it. Yes, it seems we are only appreciated when we go out of our way to provide that expected service and give something extra as a reward to those who come in thru our doors. XYZ and big business have taken our friends and neighbors and wooed them to the point that they are usually just drones following directions. We will have those folks, as will you, in January as Walgreens will be referring to us all the followers of Express. We need to do our best to let them know that we are taking their crap insurance because unlike their company, we do care for people and most of us operate at a loss because we care. I know I am supposed to be merry and jolly today but getting a 217 page provider manual in the mail from CVS/Caremark today and getting a 20 page fax from them also today just tends to make me a little grinchy. Keep the faith my friends because tomorrow is just around the corner and just when we think it's going to get better, it doesn't. So, when times are bad and we think we need to throw in the towel, look to what's really important. Your family and those around you that support what we do day in and day out. You may not have your loyal customers (whatever) but you will always have your friends and family. Cherish your day tomorrow and remember the reason we celebrate Christmas. It's not the stuff or the food. It's the life we have been given by he who sacrificed all. Merry Christmas.
Kris

AMMO & Uncle Scrooge

Hey Kids, ever been hunting? Getting up early in the morning to go into the woods before daylight so you can bring home the deer bacon?  Well, New York has gone into the woods and bagged a big ole mouse.  What, a mouse?  New York just passed a bill prohibiting mandatory mail.  Sounds good, but the problem is that it exempts government plans AND union negotiated plans.  What's left?  Not very much I could guess.  Why in the world when pharmacy organizations try to do the right thing they don't stick to their guns and fight for what's right.  You hear, "well, we couldn't get it passed without making concessions and this is better than nothing."  Congratulations New York, you've gone hunting and with your AMMO and all you can bring home is a mouse. You left the big game in the woods.  May your next hunting trip turn out better.  Now for Uncle Scrooge.  We all have an Uncle we hate to see at our family reunion.  He may be the guy who always gave you noogies or smelled bad.  One of independent pharmacy's uncle is our local government.  Recently around our state the county and city governments have been giving out discount cards for local residents.  These guys have been wooed and swayed by those sweet talking PBM discount card folks.  The government agencies are just trying to help the underprivileged folks in their town (they say).  Bless their hearts, they really do care.  NOT..just another way to line their coffers.  You see for every dollar spent on the card the agency gets a REBATE and the pharmacy who accepts the card gets SCREWED !! As long as there has been pharmacy there has been compassion for the poor and no one cares more about folks getting their medication than your local independent pharmacy.  The caveat is WE determine to who and when we want to give away OUR discounts.  I bet the local government agency never asked the PBM discount card folks how much they negotiated with the local pharmacy to determine the discount.  I bet they didn't talk with their local pharmacy to determine if this was a program in which they agreed to participate. I think that when they heard how much their government could potentially make off the backs of their own neighbors (the pharmacies) all thought of compassion went out of the window.  SHAME on the league of municipalities and the association of county governments.  You guys are hurting your own local business owners.  Did you even try to talk with your local guys about developing a program that accomplishes the goal of taking care of the poor without the PBM discount card folks?  No, I bet that when the dollar amounts started flowing your little heads had visions of sugar plums.  Now, I know times are hard (especially at independent community pharmacies) and our local governments need all the revenue they can get to keep county and city services running smoothly.  I have an idea for you.  When we do (rarely) accept a new insurance plan we have to provide the plan with tons of info.  Pharmacy license, proof of liability insurance, DEA license, etc.  Guess what they provide us with?  NOTHING !!  The PBM's have record profits (they almost have a license to steal) and they don't have to register with ANYONE.  My question and suggestion is this.  Why not?  If I have to have a state license, a county license and a city license to fill prescriptions in a business I own, then why not the PBM's.  Their profit is derived from contracts they have with payers whose employees get prescriptions at the local pharmacy.  So governments, where is their business license?  If I can't do business without one, how can they?  I would suggest that if all local governments made the PBM's buy a business license they would make many many times the money they would on offering a discount card to residents.  Just think, if a pharmacy has a million dollars of payment from say, Medco, then why wouldn't Medco pay a business license based on the million dollars of sales that they generate?(We don't generate the sales, we don't negotiate the contract with the payer and we don't issue the insurance card)  If Medco had to pay a business license based on sales,(let's say 2%) then that million would turn into about 20 grand for the municipality.  Now, multiply that by the number of pharmacies that are in your county and city and the number of PBM's that do business in your county and city.(a very large number)  I say, if PBM's are giving away my discounts and claiming my sales and inventory as their own, then let them pay for the same things for which I have to pay.  Make them pay for a city business license, a county business license and a state business license.  Since they claim they are such a big part of pharmacy (re: the new Health Springs ad on TV and how they prevented an interaction) make them register with the board of pharmacy and the medical board.  These companies are all in top 100 Fortune 500 list.  If they do business locally then make them pay locally.  The only way the PBM model works is because the PBM's are not regulated, hence, not taxed and properly licensed.  The way I look at it, PBM's are paying independent pharmacies rock bottom fees to perform a service for them, so anything we can do to help our local governments collect their fair due from the PBMs should be on our New Years resolution list. We should suggest that the government agencies start with their own PBM plans. Maybe someday soon the PBM's will be required to send us their license before we can fill their prescriptions. Sounds kinda nice doesn't it.  PBM's are constantly hiding behind contract law so I say let's use contract law to make them play fair. Let's get them licensed and registered. When Medco/Express Scripts, Caremark, and other PBM's all have to have licenses in every city, county and state in the country, it may not be such a profitable business model after all...
Kris

Lipitor My Lipitor

Did you read the news last week?  Pfizer announced they would offer their brand Lipitor to PBM customers at the generic copay rate.  Wow, what good corporate citizens.  There were many newspaper articles that said Pfizer would give up at least half of their profit on each 90 day supply of Lipitor (about $100). Considering the cost of 90 Lipitor to be around $450 dollars for 90 tablets,that would be a $200 dollar profit after expenses like: TV advertising, cost of sales people, etc.  I just looked at my reimbursement to dispense a 90 day supply of Lipitor from one of the top 3 PBM's (hint: Express Scripts) and guess what my reimbursement just happened to be?  Let me tell you. (I hope I don't get arrested) I was paid $451.45 for the cost of the drug and a 25 cent dispensing fee.  So if the newspapers got it right, I made a large $1.45 for buying the product, stocking it in a legal licensed pharmacy, having a professional dispense the product to the patient, and, including a bottle and label to boot.  If you are keeping score, it's Pfizer $200 and me $1.45.  The difference is Pfizer's $200 is net profit and mine is gross profit.  My patient paid me a copay of $9.00 today for 3 months supply and Express will send me the rest in about 30 days.  I guess the liability insurance I carry in order to fill prescriptions and the license that I have to buy from the state and the DEA license I have to buy from Uncle Sam have been reduced  (not on your life) because the payers and PBM's don't value the service I provide to my customers.  Service like coming back to the store in the middle of the night to fill a hospice prescription for a dying loved one, Service like free delivery to the elderly who don't drive or live alone, Service like holding tickets for prescriptions til pay day.  I guess the payers and PBM's don't care about their employees getting services like these.  Helping people is the reason most of us pharmacists went to pharmacy school.  It's a sad day when our society allows big business like PBM's to drive the profit down in our home town small businesses so much that many can't afford to pay their power bills.  I am happy that Lipitor users will get it for the generic copay.  I just wonder why Pfizer couldn't be a good corporate citizen and just drop the price of the Brand Lipitor to the generic price (about $200 for 90 tablets).  My cost would go down, I would stock Lipitor and not the generic (as much) and everyone would be happy.  Well, except the folks that have back door deals with Pfizer. (PBM's and many payers).  I just happen to like watching "Boardwalk Empire" on HBO.  It's about Atlantic City during prohibition and how mobsters became popular with governments and employers.  Al Capone had many back door deals to sell illegal alcohol and strong armed many businesses in order to keep his profits high.  Our government eventually got Al and set up rules that would help protect small business from ruthless businessmen like him.  It seems to me that many of the PBM's took a page right out of old Al's playbook.  (on a side note; did you know that when prohibition started Walgreen's only had 10 stores and when prohibition ended 7 years later they had 500 stores?  Talk about making hay!)  I have to start wondering when our profession is going to wake up and demand reform for payment.  Reform for product payment (prescriptions) and reform for professional services.  If we don't do it, who will?  If the Express Scripts/Medco merger goes thru then about 40% of my business will be Express Script.  Hypothetically if I do 1000 prescriptions a day I would do 400 ES/M prescriptions.  I would make about $180 bucks.  If I sold potato peelers (like the guy in New York (Joe Ades) who put his daughter thru Harvard) I would make lets see: 1 peeler for $10 or 3 for $20, and I sold 400, I would make around $2500. And no pharmacy school, no professional liability insurance, no building, no employees.  As you see, I digress.  You get the picture.  We are being insulted every day in our profession by those business people who sign these bad contracts.  No longer can we afford to do this.  Big chains don't pay what I pay for Lipitor.  Neither does mail order pharmacy, hospitals, state governments, health clinics and many many other types of pharmacy.  Community independently owned pharmacies pay the highest price for drugs in the United States.  That is why ladies and gents we are an endangered species as we exist today.  We are the subsidizers, the brokers of free service and advice.  We are determined to take care of our patients no matter what it means to our businesses.  We have to take a dose of reality and realize that we can no longer give away stuff for free (like medicine spoons and droppers just to name a few things) or our advise.  If we are to continue to serve patients there may come a day when we charge extra to put the pills in a bottle, or charge for the prescription bag.  Don't laugh, banks are doing this every day.  It seems everyone is increasing prices on goods and services except independent pharmacy.  BTW, if you agree with me, protest.  Don't stock brand Lipitor.  Switch them all !!! Be a Rebel.  Tell your patients and customers how America pays more for prescription drugs than any other country in the world.(even though we use more drugs than any other country) (kinda opposite of how Walmart works).  Ask them to help you.  Get them to talk with the mayor about that discount card the city is GIVING away. (ask them how much money the city makes on the card program).  Get involved today.  You may be selling potato peelers if you don't.
Kris
ps.. I am a pharmacist not a CPA, but even a pharmacist can tell when they are being hosed!