This morning I got a call from a physician on the east coast, who part of his/her practice is treating addicts with Suboxone. Not every Physician can prescribe Suboxone, a physcian has to take special training and gets a distinct DEA number.
This physician practices is a rather rural part of this state and apparently all of a sudden the Pharmacists at the local BIG BOX STORE… informed the physician that they were no longer “professional comfortable” filling any of the physician’s controlled prescriptions.
I am not going to mention the name of this BIG BOX COMPANY that is based out of Bentonville, Arkansas. But this is not the first time that I have heard about this company doing similar things. Several months ago I was contacted by one of this company’s Pharmacist/PIC who had diligently grew a pt base of legit chronic pain pts. This store was in a state on the Gulf of Mexico. This PIC was told by District Manager/HQ that the pharmacy had TOO HIGH a percent of controls and that the corporation was MANDATING that the Pharmacist “eliminate” a certain percent of the pts that had been getting their pain control meds from this particular store. If fact, the Pharmacist’s ability to order controlled meds was limited at the warehouse/wholesaler level.
No matter which group of pts that you are talking about, both are trying to maintain their quality of life and trying to be a good spouse, parent/grandparent, employee and/or member of the community. Apparently the management at the HQ of this BIG BOX STORE could care less about these pts’ quality of life.
Personally, I consider it a disgrace that this company who promotes itself as a “great American company” and mistreats pts in such a manner. I am only aware of these two locations that have done this to pts, but where there is smoke there is FIRE.
Personally, I refuse to BEG any company to allow me to patronize them and give them my money. If they want me to BEG… they don’t deserve my patronage
Filed under: General Problems
I say that any pharmacist who refuses to fill a legitimate and timely prescription has ceased to BE professional! A pharmacist hasn’t been to med school and cannot prescribe and shouldn’t have any say over what a physician prescribes! After I move if I am lucky enough to find a doctor who will prescribed my medication I will continue with Fred Meyers pharmacy as long as they continue treating me with respect but if forced to change I will attempt to find an independent pharmacist.
Coresponding liability says otherwise
It is called CORRESPONDING RESPONSIBILITY
http://deachronicles.quarles.com/2013/08/a-pharmacists-obligation-corresponding-responsibility-and-red-flags-of-diversion/
A Pharmacist’s Obligation: Corresponding Responsibility and Red Flags of Diversion
Corresponding responsibility is perhaps one of the most commonly misunderstood and/or (unfortunately) unknown concepts found in DEA’s regulations. And yet, enforcement actions against pharmacies are most frequently initiated when a pharmacist fails to exercise his/her corresponding responsibility. I have had countless conversations with practicing pharmacists who are either unfamiliar with the concept of a “corresponding responsibility” or don’t understand how to apply it in their daily practice. The DEA’s regulations (21 C.F.R. § 1306.04) addressing corresponding responsibility state A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances. In layman’s terms the regulation states that the pharmacist is in the same position as the practitioner who issued the prescription (but without having actually conducted a medical examination of the patient) and must exercise professional judgment to determine whether a prescription for a controlled substance was issued for a legitimate reason. While the regulations do not provide additional insight on how to exercise corresponding responsibility, DEA has created the notion that pharmacists must identify (and resolve) certain red flags before a prescription for controlled substances is dispensed. Discussions of common red flags can be found in Final Orders issued by the DEA in administrative proceedings and in presentations given by the Agency in public forums. Red flags may include:
“Pattern prescribing’’ – prescriptions for the same drugs and the same quantities coming from the same doctor;
Prescribing combinations or “cocktails” of frequently abused controlled substances;
Geographic anomalies;
Shared addresses by customers presenting on the same day;
The prescribing of controlled substances in general;
Quantity and strength;
Paying cash;
Customers with the same diagnosis code from the same doctor;
Prescriptions written by doctors for infirmaries not consistent with their area of specialty;
Fraudulent prescriptions.
But does identifying red flags really mean you are exercising your corresponding responsibility as required by the regulations? In the DEA’s eyes, are pharmacists only appropriately exercising their corresponding responsibility when they decide not to dispense controlled substances to a patient whose prescription sets off one or more red flags? How many and/or what combination of red flags must be present for a pharmacist to decline dispensing a particular prescription? Is it time for the DEA to update its regulations to provide clearer guidance to pharmacists? While the answers to these and other questions are not readily forthcoming, it is clear that a pharmacist cannot simply defer to the prescribing practitioner and must exercise his/her independent judgment when determining whether a prescription was issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.
So the DEA is mandating that Pharmacists act outside of the authority granted them by their Pharmacy Practice Act. Establishing/confirming a pt’s diagnosis – basically giving a second medical opinion – without doing a in person medical exam of the pt…not having access to the pt’s entire medical history… I just wonder how many pt’s with non-controlled prescriptions are turned away because the Pharmacist is “not comfortable”… if that number is ZERO.. then the pharmacists are discriminating against pts that are covered under the Americans with Disability Act. But apparently the various Medical Licensing Boards and Boards of Pharmacy don’t have the balls or the backbone to charge Pharmacist with attempting to practice medicine without a license. Since diagnosing and prescribing are not authorized by the Pharmacy practice act.
It’s not helping any that insurance companies are trying to push patients to certain stores that are refusing to fill scripts.
Id be worried about a knock on the door by dea,,,Im just waiting in our small town,,since they put a big red circle around adams county,,,as a high o.d.; county in Wisco,,,our pharmacist is thee only 1 for 40 miles in either direction,,,but they don’t care,,,we need to get it back as it once was,,,our medicine,,,,is MEDICINE,,, not some street drug,,,it never was,,,,mary