Denial of care… continuing and growing ?

Dear Steve,

I have pudendal neuralgia (on my right side) and interstitial cystitis. I’ve been following your work for awhile and I was one of the patients who spoke to the Department of Health & Human Services Pain Task Force in DC last year. I also follow Red Lawhern, (along with other excellent researchers on this topic), and have been an advocate on behalf of myself and others for the last 3 years or so. 

I’ve been fortunate that I’ve been able to maintain a good medical team, though I must admit I live in fear of my pain management doctor being raided by the DEA even though he does all the due diligence possible. 
I ran into an interesting problem the other day and I’m not sure if I have any recourse. I would appreciate it if you can weigh in. I’ve been taking 2 schedule 3 pain medications along with a very, very low dose of Klonopin daily. I’ve been taking this combination for awhile with no concern expressed by my doctors office or pharmacy. In fact, all of the doctors on my team are supportive of my protocol. 
My doctor tried to call my Klonopin in to Wegmans pharmacy  last week, as we have in the past. My doctor was told that they will no longer fill a benzodiazepine with an opioid pain reliever. My 3 doctors were surprised and I decided to call the pharmacist myself. After talking with the pharmacist at length to reassure him about my medical condition and explain that I’m one of the patients that takes my medication as prescribed… he acquiesced that they could continue to fill them as long as I kept my dose low. 
He told me that the pharmacy had been harrassed by the medical board and were all in fear of losing their license if they filled a benzodiazepine and pain medication together. He also cited the CDC guidelines that discourage (but do not entirely prohibit) the combination. 
Red Lawhern provided me with some research from UNC Chapel Hill that proved that the drug combination was generally safe when used as directed, but the pharmacist was not swayed. They simply had too much fear of the regulatory bodies that could take their license. My pain management doctor showed the pharmacist research that suggested that my incredibly low dose could not possibly cause an overdose, but again, the pharmacist was not swayed. 
Do I have any recourse? I felt uncomfortable when I realized I needed to disclose my diagnosis in order for him to fill the prescription. I also felt uncomfortable that my pharmacist was allowed to question the sound judgment of 3 different doctors who know me well. I certainly don’t mind my pharmacist asking questions and verifying things with my doctor, but I think that creating an overall rule that they will not fill this combination of medication goes too far. 
However, they seem to be embolded by the current CDC recommendations. I am having a hard time understanding this when those guidelines were only created for primary care doctors and not meant to be used by specialists or pharmacists. 
Can you give me some advice? I do understand my pharmacist feels stuck in the middle of a regulatory mess. I am trying to be empathetic but I think I need to report the situation if you think it would help other patients. 
Best regards, 
This pt has been going to a grocery store chain pharmacy and it would seem what they are running into is that the corporate HQ has been intimidated by some part of some bureaucracy and/or they are concerned about being drug into the law suits that are currently going after the pharmas and wholesalers. I suspect that the chain pharmacies and the insurance/PBM industry can’t be far behind in the law firms going after more money ..because they will claim that they facilitated the opiate crisis by providing and/or paying for opiates for pts who had a valid medical necessity.
This seems to confirm what I have suspected for some time,  some corporations have went so far as to turn their employee pharmacists into nothing more than puppets to the corporate demands on what meds or combinations of meds will or will not provide to certain pts.   Has these corporate demand being instigated by the DEA or by their legal council ?
From what this was stated by this pt… this corporation has taken upon itself to basically revoked the professional discretion of their employee pharmacists and impose their opinions,  Which since the corporation can only have a permit to operate a pharmacy not the practice of pharmacy they have appeared to exceed their legal authority.
However, we have a very serious and growing Pharmacist surplus and it is claimed that the 140 odd pharmacy schools are graduating 15,000 new pharmacist each year and there are MAYBE 10,000 open job slots to be filled.  Many of these new Pharmacists having SIX FIGURE student loans hanging over their heads.
So those Pharmacists who have a job, know that they can be easily replaced by young and eager – in debt – Pharmacists may accept a lower hourly rate.
To date, the corporations that are taking such actions have no reason to fear pts being denied care… no one has sued them…  Actions that have no consequences, typically are repeated until there are consequences.
Here is a website to help pts find independent pharmacies  http://www.ncpanet.org/home/find-your-local-pharmacy where they will be dealing with the Pharmacist/owner and unlike the corporate pharmacist that collects a paycheck every couple of weeks… regardless if they deny filling valid Rxs or not … only get paid when they fill legit prescriptions for pts with valid medical necessity.  The over whelming majority don’t have “deep pockets” … so there is nothing for the bureaucrats to fine…  if they do fine the independent it would probably mean a closing of the store because they cannot afford to pay the fine.

2 Responses

  1. Can the pharmacy be sued for not providing medication? i would think so,but you never know today

    • Probably, but it would take proving that the corporation had implemented policies and procedures that would require the pharmacists to deny care to a whole segment of pts – especially those whose medication was for what being prescribed to improve and maintain the pt’s quality of life. Find a corporate pharmacist that they have fired for ignoring their edicts… to document that the corporation did distribute such edicts

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