When MASS Medicaid says that a pt should not have a opiate Rx … they mean it !!!

Rite Aid pays $177K to settle improper drug-dispensing allegations

https://www.beckershospitalreview.com/pharmacy/rite-aid-pays-177k-to-settle-improper-drug-dispensing-allegations.html

Retail pharmacy chain Rite Aid will pay $177,000 to resolve allegations that it violated Massachusetts law by accepting cash payments from Medicaid recipients for controlled substances instead of billing the agency “in a limited number of instances,” according to The Boston Globe.

The lawsuit, brought by Massachusetts Attorney General Maura Healey, claims that in some cases Medicaid had denied a claim for a controlled substance like opioids, and a Rite Aid pharmacist dispensed the medication anyway for cash.

Rite Aid denied violating state law and told The Globe that the settlement  is to avoid the uncertainty and expense of litigation.

Under the settlement arrangement, Rite Aid also agreed to train all pharmacy staff about Medicaid regulations and require all pharmacists to consult the state’s prescription monitoring program before dispensing controlled substances.

A similar agreement was reached in 2016 and 2017 with CVS and Walgreens, which also were accused of violating controlled substance drug-dispensing rules.

 

9 Responses

  1. CVS advised me they no longer will fill narco over 7-10 day DEA recommendation (not a law yet). Live rural area with only 4 national pharmacies, the CVS guy said he didn’t want DEA down his back. Only way to fill RX was to get PA thru my Part D/Silverscript & pay whatever it cost. I questioned if GoodRX was cheaper, would CVS honor coupon. CVS, Walgreens & Walmart are forcing patients to use Part D Medicare & refusing GoodRX lower prices.

    Kroger Pharmacy was allowing 1 mo suppy thru GoodRX (not sure if they are in 2019)….but if you live 75 miles in a metropolitan area, this same Brand Pharmacy/Kroger has no problem honoring a 3 mo GoodRX narco script. GoodRX says it’s up to pharmacy discretion. This seems like it is discrimination for a handicap patient living in a rural area…because ALL of the rural pharmacist have banned together to follow DEA recommendation, force patient’s to use MEDICARE and pay more.

    It’s verty frustrating and emotionally draining. I’ve been with my rheumatologist 20+ years, he is a reputable Dr in Indpls who has written lots of books on fibromyalgia/pain, works within a group of other pain management Drs, has never had an issue with prescribing me pain meds to function, has done PT scripts & injections with minimal long term success. I’ve had a failed knee replacement & severe OA. I’m permanently disabled and can’t fight my 4 local pharmacist for fear of not get any of my Medicare pain meds filled, I’m forced to pay higher cost due to no one honors GoodRX in rural area, I fear pick up my script in big city when I see rheumatologist …because I don’t want to be questioned why my zip code is an hour away & script not being filled with my local pharmacy. I don’t want to risk loosing my disability questioning gvt guidelines. Somehow it seems like my rights are being violated forcing me to use Medicare and forcing pharmacist to be afraid to honor GoodRX lower cost…just because it’s a rural area.

  2. That’s Bullcrap. Just because we have medicaid and I get a script for pain medicine and I go to a drug store that I’ve been going to for years and he or she tells me it isn’t covered so I have to do a prior authorization and if that gets denied thats my choice if I want to pay for my script because I choose to have the medicine I’m prescribed for the chronic pain I am in everyday. No insurance company especially medicaid has the right to tell a pharmacy that I can’t pay for it if they aren’t going to cover the medicine because that’s morally wrong. They are crazy. I never heard such bologna in my life. Then medicaid better pay for all the meds I get prescribed
    Because if not I will pay for abything they don’t pay for. This is very serious, when you are on meds for awhile you can’t just stop taking them because they don’t go through medicaid. I will get my script one way or another and nobody will stop me. This is so wrong to do to people who are suffering and the pharmacy has no right to say no to us on a script a doctor gives us. They are the knew you go get the pills at and that’s all they are there to do. This needs to stop now. This pisses me off. We chronic pain patients don’t deserve this treatment from anyone.

  3. Pay CASH. F Medicaid, F Medicare, F Insurance!! They do not rule my LIFE.

  4. wait a minute…has Mass put in placed the blanket ban on opioids for all medicaid patients that Oregon is about to, or are they merely being even more ignorant & sadistic than the rest of the country? If a person has a high BP medication denied payment by medicaid, do the DEA/cops/etc go after them?

    And will this BS NEVER end?!?!

    • It’s not a ban on all opioids (yet). They have prescribing limits, so some people are still able to get a certain number of pills each month, but……it won’t surprise anyone to see this change to a full ban if the tide doesn’t get turned by CPP’s fighting this issue and the Operation Starburst is a critical component, so everyone needs to join this class action suit, no matter what state they reside in (it’s a federal suit so anyone in the US can join it).

  5. Why is it a problem if you pay for a medication that your insurance doesn’t cover I don’t understand this It’s saving the insurance company money what’s the big deal

    • The DEA considers it a RED FLAG for a pt paying cash for a controlled substance when the pt has insurance – because that is what substance abuser/addict and diverters do… so in the DEA’s mindset anyone who does this must be a subtance abuser/addict or diverter… In this situation people who are on Medicaid are supposedly on Medicaid because they are POOR… and apparently in MASS they have declared that when Medicaid decides that they do not want the pt to have a controlled substance.. that is a ABSOLUTE DECISION. And it would appear that the law holds the pharmacy/vendor responsible to enforce that determination. Maybe that part of our declaration of Independence referencing Life, Liberty, Pursuit of Happiness has been rescinded for Medicaid pts in MASS ?

      • Geez not to mention its against the law for the government to practice medicine as they have been,,,ALLL OF THIS,,ALL OF IT,,, has been 100 %%%%% corrupt,illegal by our federal and state governments..What I don’t understand is why they pharmaceuticals/pharmacy’s don’t fight back??There are some very very legitimate reasons for someone to pay cash for their MEDICINE,,, house burning down,tornadoe,robbery,insurance won’t pay,,etc,,,,Dea see our medicine as 1 thing,,a drug,therefore corralates any activities around our medicine,they appear to perpatrate a prejudicial.bigotry,onto all the legal legitimates uses for our medicine,,,again,,,AGAINST THE LAW!!!!maryw

      • This as absolutely true! It happened to me a few years ago! I was fortunate that my pharmacist was a decent human being. I was due to fill but for some reason my insurance said I wasn’t and denied coverage. My pharmacist knew I was due to fill and allowed me to pay cash. He said I should be reimbursed when the insurance company discovered their mistake, but they refused to ever acknowledge any. Typical. I have a real problem with the fact that somebody at the insurance company can decide that they know more than my doctor. Isn’t that practicing medicine? My doctor, who knows me, my history, has examined me, and has been treating me for years, has decided that I need a certain medication and somebody that has never met me, nor examined me, can change or cancel my prescription? I cannot imaginehow that is not considered practicing medicine. I cannot imagine how that is legal! It is absolutely infuriating and nonsensical.

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