Pain Medication Acquisition Problems Growing, NCPA Survey Finds

NCPA has out a survey asking RPH’s if they are having more and more problems acquiring control meds… while the survey is still open.. here are some of the first comments:

For some time NCPA has been aware and working to resolve the issue of an increasing number of pharmacies being unable to procure controlled substances to fill prescriptions. This, of course, is a great concern not only for our members but for patients who need these medications most often to treat acute or chronic pain. To better understand the prevalence of this situation and its impact on patient access, NCPA’s most recent action was to send a member survey you should have received earlier this week.

Is there a problem? The 120 responses we received in the first hour amply demonstrated that there is one, and it is widespread.

We are still compiling and analyzing the results, but the open-ended comments are both compelling and revealing:

  • “We turn away patients on a daily basis that I am sure are legitimate patients with legitimate prescriptions with legitimate issues requiring pain management. I am one in a long line of pharmacies that turns these patients away because of the limits on what I can dispense monthly.”
  • “…recently I’m very concerned that, as a result of taking on patients who are opiate refugees from other pharmacies, we’ve elevated our visibility with our wholesaler and will soon be ‘whammied’ with more stringent monthly allotments.”
  • “We have recently been inspected by our wholesaler. This is an effort to make sure that we are dispensing appropriately. The problem is they ask for statistics such as percentage of controls versus total Rx volume. These numbers need to be adjusted as our volume of maintenance medications continues to be reduced by mandatory mail order programs.”
  • “We were informed by our [X] wholesale rep on Oct. 29 that our hydrocodone percentage was above their ‘average’ and that our purchases would be capped beginning Nov. 1. They would not give us the amount at which our purchases would be capped or how the ‘percentage’ was calculated. The local rep would only say that the DEA [Drug Enforcement Administration] was mandating that they decrease the amount of hydrocodone they were shipping and that their new practices were a result of the DEA actions.”
  • “The suppliers are hesitant to give us guidance. When they do, it changes on the fly. They are terrified of the DEA.”
  • “We cannot obtain any alprazolam after about 2 weeks into each month and cannot obtain hydrocodone by the last week of the month. A competing pharmacy cannot obtain oxycodone after about 10 days into the month.”

There were more examples like those above and more are still coming in. The survey is open until Dec. 18. As you fill out your survey, think of specific patient examples in which being limited or shut off has affected their care and include those in your survey.

What makes this issue complex is that there is a prescription drug abuse crisis in this country that has to be addressed. DEA seems to have decided that the wholesalers are the choke point (a cynic might add that they also have the deep pockets to pay huge fines levied by the DEA).

So, how many other disease states.. can you name,  where our government and our society DISCOURAGES healthcare professionals to provide adequate/aggressive therapy for a pt’s medical issues ? Imagine what would happen if a prescriber allowed a pt’s blood sugar to be in the 250 + range, or their blood pressure > 200/100 and/or lipid at 250-300 or more… can you say MALPRACTICE !

Leave a pt suffering from under/untreated pain and they get “two thumbs up “.. can you say MORONIC !

20 Responses

  1. Well once again I’m denied my prescription to not be filled by Walgreenns I’ve been filling there for over a year and have been getting pain meds since 08 they just told me that since my doctor isn’t in the same county as their Store they refused to fill them !I am on disability and have been injured and I’ve had 14 surgeries in the last nine years nine of them in the last two years I’ve been trying to get better but nothing seems to work I’ve been actually going to the Cleveland Clinic in Florida and driving six hours to see my surgeon and now Walgreenns will not fill my prescriptions what can I do?

  2. Can a pharmacy pan certain Dr that allows me not to get my scripts there

    • It would seem like some of the chain pharmacies have without any consequences… it seems as long as pts keep going back to them and giving them their money they will continue to do what they want

  3. Pharmacy refused to fill pain med prescription from dentist after a root canal because it was written on the wrong kind of paper. The Dr said he never heard of this and only has one kind of paper he writes prescriptions on. The pharmacist wrote all over the prescription and put stickers on it so it could not be taken any place else.

    • Here is a list of all the boards of Pharmacy https://nabp.pharmacy/boards-of-pharmacy/ call the BOP tomorrow and ask what the requirements are for C-II in your state. Be prepared to fax/email a copy of the rejected Rx… as proof as to what the pharmacist did to your prescription and resulting denial of care… If the pharmacist is screwing with you… ask the BOP how you file complaint in regards of unprofessional conduct, denial of care and pt abuse

      • Lol you are comical, meanwhile people are literally dying of opioid overdoses. No one thinks they have an opioid issue until it they themselves become a statistic. If you were a moral patient advocate, you’d keep up to date with the latest CDC guidelines, and instruct patients to address their underlying cause of pain. BTW, complain all you want about to the BOP, 95% of the time the pharmacist has a legal and legitimate reason to refuse. You are a sellout to your former profession and a quack. But since you seem board have fun encouraging people to complain endlessly and waste their time as well as the pharmacist and doctors.

        • I am approving your post so that those chronic painers out there can see the “mindset” of the typical opiophobic pharmacist… and especially those pharmacists who do not have the “BALLS” to post using their name and email… but has to prove their “correctness” by “hiding” and only posting anonymously. So easy to place labels and call names while you hide… but your IP address 24.236.89.4 indicates that you are currently in the St Petersburg, FL area… GREAT STATE OF FLORIDA .. where the term “pharmacy crawl” was coined because of the Pharmacists’ refusal to fill got to epidemic level.

  4. It’s all well and good that you’re voicing the problem, but write to your Senators and Representatives in Washington. Explain that the DEA is behind this. They want to hear from you!

  5. Dear Steve I tried to get my carisoprodol for my muscle pain I do take other meds for my chronic pain I have had 6 back surgeries and a neck surgery since 1986/2014 I am in constant pain I try to live as normal life as I can. I have to take meds to go to sleep at night I have high anxiety I have been advised that I have a failed back, that I just have to live with the pain. I refuse to take stronger pain meds than hydrocodone10/325 because I don’t want to feel like a zombie, I was refused my soma from your pharmacist Alex at the San Bernardino store, no explanation she was just rude, she spoke with my Doctor she was rude to him as well. He gave her a complete reason for my meds and why I have to take them, she still refuses to let me get my meds from Costco…!!!

  6. November 2015 my big box pharmacy was told by the distributor that we exceeded the “OMP THRESHOLD” for Hydromorphone.
    I did not know what OMP was, so I inquired and it’s a “Order Monitoring Program”. The details of the program could not be explained concisely by the first and second contact at the distributor. When I inquired how to lift or expand the limits of the threshold I was told I could submit a form to do so. The required data was far beyond what I could assemble at store level so I called home office to seek resolution.
    Since then I have been told no attempts to raise the threshold would be made as doing so is not in the company interest as the process is lengthy and draws attention to the sale of opioids. Additionally, my store alone had a haphazard “guideline” created during a 90 minute conference Railroaded in to place. This guideline removes the pharmacists’ professional judgment in assessing each Rx for validity and requires actions beyond the scope of pharmacy practice. The guidelines mandate that beyond 60 days of IRO therapy the patient MUST move to ERO therapy and that IRO Therapy can only be maintained in conjunction with an ERO. Secondly, any RXs beyond 60 days must be generated by a “CERTIFIED” pain management specialist. Beyond 60 days IRO medication can not exceed 120 tablets per month.
    At beyond 60 days only a 14 supply may be given to prevent withdrawal and time to find specialist.
    This indiscriminate policy is full of ambiguities and has already prevented access of mess to many established and elderly patients. If it is applied company wide it would be very detrimental. It stomps on patients rights for choice of doctor and pharmacist and the professionalism of pharmacy….

  7. I live near jacksonville in callahan(Nassau county)I get 120 oxycodone and 100 microgram fyntanal patches both for 30 day supply.I went walgreens a lil over three months ago and my doc accidentally wrote my scrips wrong,he wrot 45 day supply of 50 mcg fyntynal patches and 120 30 mlg 5 to 6 a day witch is a 20 day supply and insurance wouldnt cover because of that and I got denied and pharmacist said I have to wait 90 days before I could try back again.now all of my prescriptions are right but the secrectchecklist said if I’ve been denied by a Walgreens they will not fill them but she said I couldnt try back for 3 months.does any one know if I should not try and fill the patches or should I try everything because ive only been on the fentanyl for 4 months and the secret checklist said I need to be on the same medication for 6 months.please help???u can email me at gleaton.bobby@yahoo.com thanks

  8. Hi pharmacist Steve,

    I’m sure you speak with many people however I’m hoping you remember our conversation regarding pharmac at cvs who violated my hippa

    ive filled four complaints against the pharmacy in general. The last complaint which was made because the main pharmacist in charge was on vacation so, of course there was another “temp pharmacist”. I came in 1 day before my refill was due and as the pharmacy technician like always has to ask the pharmacist “temp” at this moment and its a C2 controlled substance. I know that They have the medicine in stock but after the temp pharmacist looked at my prescription, without even looking by checking the safe where the regular full pharmacist has to go to fill it. He bluntly lied to my face and informed me that he didn’t have that prescription in stock and like the majority of pharmacist assumed I’m some drug seeking addict.. But, anyways I first informed him that sir, you do I fact have it in stock as the main pharmacist keeps it in stock as I get it filled every month. I then continued to direct him to please actually open the safe under you and actually look. Guess what…? He has it!!! Go figured right. Then, as I’m still standing there with people other customers behinde me, he looks at my prescription and looks at the bottle of medicine that he said he did t have then looked at me and loudly asked from the middle of the pharmacy area ” WHAT ARE YOU GETTING TREATED FOR??” He DID NOT ASK ME TO come to the CONSULTANT DESK and I was already embarrassed by the way he was treating me then I had to loudly answer back where everyone else in line and also picking up their rx in another line could hear and know all of my medical problems and personal health and private information. After I told him what I was getting treated for he finally filled the rx..of course I had to wait over 30 minutes as I’m sure he wanted to verify the rx whih is TOTALLY fine with me and should have either done that in the first place and or ask to see me at the consultation desk and ask me what I’m getting treated for. I’ll never forget this and nener forgive cvs for this..Tim the temp pharmacist was in the wrong, violated my
    Hippa rights, and treated me unjustly. After I left I was mortified, embarrassed, depressed that I had to go through this. I looked up if there was anything I could do and I got advice from pharmacist Steve stating to file a complaint regarding CVS ciolsting my hippa rights and also I filled s complaint with the Louisiana board of pharmacy. Well, after CVS got a call from a compliance officer and spoke to the main pharmacist Jessica … I got an email from the compliance officer stating he spoke to Jessica and asked her to cal me and try to resolve the issue. About an hour later I do get s call,but Jessica just says she no longer feels comfortable filling ANY of my prescriptions.

    I will continue to tell my story regarding I was treated, labeled, and punished for filling s complaint. The point of complaints is to be able to provide feedback and the store or company to better themselves and their customer service.. But, now I have to drive about over an hour round trip to get my prescriptions now. Lawyers tell me that it would cost me more money to possibly just slap them with a fine. The compliance officer and to the companies that I have submitted s legit complaint did nothing to help the consumer.

    I hope that And know I’m not the only one out there and I pray and hope that something can get done to this pharmacist and temp pharmacist along with cvs.

    Thanks for your time in reading this

    Sincerely,
    Ronnie M

    Please support your local pharmacy sand not these big chains as they don’t give a two craps about your health or you as a human being

    Re

    Cvs store

    70550 LA-21
    Covington‎ LA‎ 70433
    United States

    +1 (985) 893-7681

  9. I am a person with chronic pain. I don’t want it and would gladly give what worldly goods I have just to be pain free for just a short time. I too would be interested in a attorney to investigate the basic human rights that are being ignored. I appreciate your willingness to air the concerns of others. Just read a similar story about a young lady that could not get her prescriptions filled from the emergency room after having her hand sutured. People need to remember that this could be them or a family member someday. She was verbally abused and threatened to have police called because she dared to question the denial. Your courage is commendable.

  10. Pharmacist Stevr, Im searching for an attorney, but they look at me like Im crazy…everyones scared of the DEA… IM NOT. NOTHING TO LOSE NOW….

  11. Absolutely insane, as a patient who has been prescribed two different opiates since 2001 to control chronic pain from a spinal cord injury, I have recently run into serious issues obtaining my monthly RX’s. I drop the prescription off to e filled prior to running out only to get a call from the same pharmacy I have been dealing with for years telling me that the DEA won’t allow them to order the drugs from their wholesaler since they have exceeded their monthly allotment. I am left without or panicking as I call around town trying to locate my drugs. Often I must go back to my doctor to get another prescription written since once of the two RX’s were partially filled which mean’t that a new prescription had to be wrote for the new pharmacy. Then they filled the second rx partially since they too ran into the same issue when ordering the remainder of my second prescription after giving me what they had on hand in their store inventory. Totally insane for an individual whom doesn’t drive due to their injury, relies on family to assist them in running them around, and can’t run out of their meds. I have actually run out on multiple occasions because of this and had to go to the emergency room for prescription refills from the hospital pharmacy. Why does the government have to regulate everything so tight that they make it difficult for those whom do nothing wrong and abide by the laws and regulations.

    • This is your typical “finger pointing”.. the DEA claims that they are not causing this and the wholesalers claim that they are responding to pressure from the DEA.. The government is bound by the Constitution of “cruel and unusual punishment” and if someone can prove the DEA is at the root of this problem.. the ACLU or some other group should come to bat for these poor patients… or.. someone get a class action together against the wholesalers – 3 majors control 90-95% of the entire market… for either practicing medicine without a license… interfering with pharmacists practicing pharmacy.. and/or denial of service and patient abuse.
      IMO.. they are taking advantage of these patients who lack the physical/mental strength to put up a fight.

      • Have we forgotten what these medications were developed for? To make people comfortable while they die. Before these were marketed, we had to be big boys and girls and handle pain. Now, you break a bone and get a script for #240 perc. 5.

        • Maybe you are unaware of the studies that indicate that pts with better pain management recover quicker ! Or maybe our society has become more empathetic of a person’s quality of life.

  12. Our pharmacy was cut off from scheduled medication without warning or reason just 3 weeks after we were named as a quarter finalist for our wholesaler’s pharmacy of the year award for our work in the Pain Management Field. In 2012 I received our State Pharmacy Association Innovative Pharmacist of the Year award for my work in Pain Management. In our semi-rural area, there were no other pharmacies that could take in our pain patients. We had two reported suicides, one medical death we believe was related, multiple hospice admits, multiple ER admits, some hospital admissions, and lot of lost function and quality of life. Now we hear that restrictions are growing. Pharmacies that were unaffected by the summer controlled substance cut-backs began to experience cut-backs in the fall.

    So here are the statistics: Eight million chronic pain patients are treated with opiate-based medication safely and effectively every single day in this country. About 16,000 people die each year from opiate overdose. It is believed that most of them were recreational users. A large portion of those had their medication dispensed directly from the ‘physician’ at a clinic. (FL no longer allows this) About 16,000 people die each year from NSAID use. It is believed that they are not recreational NSAID users. The CDC announced this year that about 23,000 people die each year from the consequences of antibiotic misuse.

    I believe the above speaks to the need for local pharmacists who have a relationship with their patients and the time to counsel them, and monitor their medication use.

    I have more than just a rant, I have a solution. go to http://www.paintrac.com and look at the CSAPP Controlled Substance Advanced Practice Pharmacy registration model I propose to maintain patient access to care. It is a workable solution; we’ve used it daily for 10 years.

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