Taking them off at the knees !

This page is a “work in progress”

Those with subjective diseases ( Pain, Mental Health, Anxiety, ADD/ADHD ) are experiencing a great deal of difficulty of being treated by our society &  healthcare system like other pts with chronic diseases.

There are untold number of rules,laws, regulations that are being broken and fractured.. some out of ignorance by some of the players, some sort of arrogance because they are hoping that ..that group of pts are not “smart enough” or not rich enough.. to “take them on”..

well.. there are many avenues that pts can take.. without using an attorney…  some fines… the pt will share… others.. it is just a matter of helping those who are “messing with you”… to feel your pain.

This page is going to be the foundation of links to other posts to help pts bring the weigh of the law on those who are marking this pt base.. Of course, those RPH’s who are looking out for and taking care of their pts.. won’t have to worry.. those that are not.. may need to be concerned…

DEFINITIONS

What is a ADA violation ?

Why won’t the pharmacy bill my insurance ?

Standard of Care & Best Practices – Insurance

Standard of Care & Best Practices – Pharmacy

Sherman Antitrust Act Violation

Go on the offensive with health care providers

Federal Trade Commission deals with consumer fraud

Suing Individual Pharmacists

Dealing with “I’m not comfortable” from Pharmacists

Pharmacists violating the Pharmacy Practice Act by diagnosing pt’s health issues

They say a picture is worth a thousand words.. what is a video worth.

Consequences of unrelieved chronic pain ?

Hate Crimes Against Individuals with Disabilities

Denial of care and TORTURE

 

 

30 Responses

  1. Way to GO Steve! Thank you very much! Your helping so many people! It’s really great! I hope we beat this soon with going after the ADA violations !! I do hope that all legitimate pain patients file these complaints without delay! It so important to our civil rights.

  2. This will be a GREAT start for us in our own illnesses and chronic Pain to fight back and I will do whatever I can!

  3. as someone who has been discriminated against since i was 16yrs old and told that my stomach pain was just for attention (i was diagnosed with crohns at 17) and RA at 23 . I think it is a very noble thing you are doing,i am sure you hear this alot but it is people like you that have cause people like me to still have hope in the medical profession because i have lost it serveral times. I now have alot of issues with my joints , slipped discs,TMJ,,etc, as well as nerve pain, spasms, endometreosis ,ulcers,etc, basically .. I need to take pain medication everyday and when i was in my 20’s i had enough problems with doctors because i was so young and the just assumed I was just abusing them ,although the good ones would apologize after seeing mri’s ,blood work, etc, . I actually had 1 doctor look at the mri of my lower back, point to where i had a chipped and narrow disc and vertibre and tell me i was too young to have this , and then told me how he took tylenol for his sprained fingers or something .. when i told him what i had been taking from my other doctor,he told me i was an addict and I needed to go to rehab… !!I was devestated i had waited like 1 month just for that appt. and was hoping to get some relief Not here that. I am 33 now, and i was lucky enough to find a better doctor even after my husband got laid off and i lost my insurance . in fact the best doctor i ever had was at a clinic for lower income patients , she treated me wonderfull and put me on long term pain meds. 1 is a extented release and i is for break through pain, I have been on the same meds since. and they have made my life alot more manageable, i still have pain but i think everyone does to some extent though. Now that i am a little older and wise I do not let bad doctors,pharamacists, etc bother me,in fact i laugh at the ones that are just on an ego trip ,one day they will be in the same situation .I also have gone to the same pharamacy for yrs because they treat me like a person,but i have sseen what this new ‘war on pain meds” has done to them as well. It is getting so out of control and those who are making these decisions regarding what is legalor not,how it should be depensed etc, should not be!!! they are clearly not educated enough on the subject. i saw an article about a lady whos son died from an overdose ,he mixed some meds,(he thing is the exact meds are the same ones i take everyday. She was now trying to get them banned so it didnt happen again.. I think her heart was in the right place but on the wrong issue, Its just like saying ban liquor or wine because a teenager died from drinking to much. I guess my point in writing this very long post was well honestly to vent but most of all to say thank you ,People like you make me think that this problem will eventually die down once more people become aware of the real issue… people are gonna abuse anything that can be , why should people who are already dealing with enough problems be punished ,maybe these parents should be talking to their children not protesting in the first place .. put the money into rehabs and help for the addicts not banning something that has a postive purpose, thats more then you can say about alcohol it doesnt help anybody . right..

  4. I am unsure what delineates the citreria of who is allowed pain relief. The navigation is such that the menacing of making though the minefields or obstructions to the path is arduous enough without more stumbling blocks and others to saw the rung of the ladder of successful pain treatment from beneath you.

  5. Thank you, Steve. Guess I’ve joined the chronic pain category after recent surgery. My bladder tore and started bleeding badly during a cyscosopy. Apparently my bladder walls have thinned from damage of interstitial cystitis. I wore a cath home for 5 long days. Saw urologist yesterday and he did prescribe Vicodin but with no refills. He mentioned pain management and patch. Have no doubt these new laws will be affecting me in future. Good luck to all!

  6. Steve, just wanted to thank you for bringing some hope back to those of us who suffer from chronic pain, and have been abused mercilessly by Walgreens and CVS. I have been unable to obtain my medications due to pharmacist refusal 3 times in the last 2 yrs. Which means I did without painkillers for 30 days and also was forced to abruptly stop medications.This sent my bp skyrocketing, caused vomiting and cramping,aching in my joints and on top of it all, forced me to lose a tremendous amount of work. Thank you for being our advocate.I am 57 years old, and never thought I would see the day when a pharmacist could refuse to fill my prescription for no other reason than “being uncomfortable”

  7. Hello Steve the second link, “Why Won’t The Pharmacy Bill My Insurance?” is broken. It redirects to an admin login page. Here is the working link for anyone else who is looking for it: http://www.pharmaciststeve.com/?p=6164

    I hope this is not too intrusive, I just figured others may be interested in the article, but may not know how to navigate to the page. I just figured I’d give you a heads up in the meantime. Hope this helps. I really appreciate all of the informative articles you’ve written/linked.

    Thank you again for being a voice of reason and hope for those of us who are suffering. I happened across your blog at a time when my faith in medical professionals was verging on an all time low. It helped to know that there was still some sanity in the profession. Because of this I felt a little less alone than I would have felt at the time if I had not come across your blog. I can’t thank you enough for that.

    Per Steve: Thanks Charles… it is now fixed !

  8. Thank you for being there for us pharmaciststeve. I follow you on facebook and twitter and Google+. I appreciate you keeping us informed. We need all the help we can get these days. I read everything you share and find it all very informative. I am so frustrated with what is happening to chronic pain patients these days. I am also frustrated with the DEA. They are treating us like drug addicts instead of patients with legitimate pain and legitimate diseases. I hate the fear that the DEA has instilled in doctors. It has made them afraid to treat us at all really. Instead we are subjected to useless “procedures” that don’t work and just make the doctors rich. It just astounds me and makes me hopeless. I keep on fighting it though any way I find. I’m not afraid to speak my mind. I just don’t feel that I have anything left to loose.

  9. Thank you for giving us hope and a voice. I have spent the last 8 years of pain clinic visits every 30 days and have never violated a policy. Now I am being threatened with medication reduction because of the amount of medication required to ease my pain. Tennessee and the DEA has decided that only a low amount of pain relief is allowed under their plan for success. Pray that I can handle their torture to this broken body.

  10. Steve,

    I’ve been reading your site for quite some time now, and like many, many others, have been verbally abused, lied to, and treated like a criminal by Walgreen’s and CVS.

    I’m done being treated this way.
    I’m fighting back, right there at the counter, stating the laws, the facts, and even showing them that I have corporate on freaking speed dial, and I’ve also been forced to start calling other places as well.
    I’ve now had to call the DEA, myself, and report Walgreen’s violations, and I’ve also called the board of pharmacists, and the medical licensing board, and reported pharmacists for practicing medicine without a license.

    I’ve been documenting the abuse for over a year with their names, the dates and times, and every single rotten thing they’ve ever said to me.

    I’m fighting mad now, especially today.
    I thought this one particular Walgreen’s just hated me, but I actually watched them, saw and heard them, do the exact same bullshit to a man in his mid to late 70’s.
    That lit a fire under me so bad today, that I came home and filed even more complaints with all the licensing boards, the DEA, and the “Consumer Services Unit” here in Florida.
    That’s the actual drug monitoring database used by the state, and they don’t just monitor pain meds, they monitor all.

    But than you so so much Steve, for doing this website, for helping people. A lot of the links you’ve posted, helped me start fighting back.

    • I recently moved to Florida and was appalled at CVS and Walgreen’s. They turned my husband away because he’s been on painkillers (2, 10mg lortab per day) for more than 6 months. Apparently they don’t know what chronic means. The pharmacist also stated that the doctors should have been able to fix his back already. I think we should start picketing at Walgreen’s here in Florida. Passing out literature about the unfair treatment of pain patients to those that do not have chronic pain in an effort to educate them on this matter might get them involved. A visual demo, I think, is the fastest way to get things done.
      Wanda

      • im want in i just moved here too an the anxiety n pain that they put in us makes me sick an pissed i have crps i moved here from wi. an ur tellen me that a small town in wi has my meds an the state of florida dont o just wait ten days u tell that to a diabetic or a guy with heart meds no just the people with pain we come here for a better life its gone too far an i want to picket ,sue an any other ideas that will wake these glorified soda jerks with a power trip im by hudson fl. let me know where to picket or i need help on how this new system works thanks

      • Maybe the doctors and the pharmacists should change jobs. Since the pharmacists seem to think there are ways to actually “fix” the causes of our chronic pain issues maybe they should be treating patients. It is obvious the doctors are unable to repair damages from traumas, autoimmune disease, inherited issues, and etc. But, I have heard several pharmacist state “why hasn’t your doctor been able to repair the spinal damage in 25 years”? My question to such a statement from a pharmacist is, “how would you repair a osteophyte complex larger than a golf ball, flattening the spinal canal at C2-3, C3-4, and C4-5”? This is only one of several medical problems causing intense pain from a serious motor vehicle accident which caused a lateral cervical fracture. I would say that the 3 years I spent attempting to receive SSDI, would have not been successful if there had been any medical treatment that could have allowed me to return to work. Surely, the SSDI doctors would have denied me if I could have been fixed. In fact I have been evaluated by more than 8 orthopedic surgeons and neurosurgeons in the past 25 years and none of them are willing to operate on all three levels of my spine (Cervical, Thoracic, and Lumbar) multiple times in order to place hardware, perform discectomys, and etc. Since I refused surgery when I was younger now the surgeons say that I have a very low probability of successful surgery at 63. There are no options for some of us except moving to a country that has decent medical care. If any of you want to comment about how good our system is please google the World Health Organization ranking of health systems in 2000. In that article the US was ranked 38th in quality , but 1rst in expense of health care systems in developed countries. I am considering keeping my SSDI here, but traveling abroad for the rest of my life to countries that have better health care and consider the chronic pain issue as a real disease that I did not want.

  11. Thank you for all that you are doing, Steve.
    My husband and I recently moved to Florida. Both of us suffer from degenerative lumbar disc disease. We see the same neurologist. I take percocet, husband takes lortab. With the new change in hydrocodone schedule, our doctor also made a change. He used to write an RX with one refill for lortab (For percocet, he would write out 2 rx’s). Now he told us that we need to drive the 30 miles to his office on non-appointment months and pay an extra $15 to pick up the prescription.
    I had to see an ortho recently due to some severe pain in my scapula. They did a cervical MRI and found a bulging disc. The orthopedic offered to take over my pain management. I’m terrified that no one will fill scripts from a new doctor, I’m sure the pharmacist will accuse me of doctor shopping. (Of course we are going to “doctor shop” to a certain extent……we have only lived here since April.)
    My husband went to the dentist several times because of dry socket. Once that was fixed, he began seeing the pain doc. I recently took our 16 year old to the dentist because she was having pain. He said the tooth had to be pulled but would not prescribe her any pain meds cause he said my husband was flagged for doctor and pharmacy shopping – even though the dental RX’s and pain doc RX’s NEVER overlapped. I’m appalled that my kids will have to suffer with future(hopefully thus is a one time thing) tooth pain and dental work because my husband saw one Dr and one dentist, and has used a few different pharmacies. (Most here in Florida won’t fill any narcotics)

    • Hello Wanda. There seems to be a lot of confusion about what “doctor shopping” means. Unless your husband actively sought and secured an Rx from more than one doctor while concealing the fact that he was already taking a similar medication (active 30 day period of the actual Rx) he was not “doctor shopping”. Perhaps this dentist you took your daughter to took it upon himself to deny pain meds after seeing multiple prescribers for pain medication, many docs/dentists are a bit paranoid or over reacting to intimidation from the DEA. I would be surprised if he was ‘officially’ red flagged. Its a shame. One cant believe half of the words out of a health provider’s mouth any more, this may be the most damaging aspect resulting from the whole crackdown on pain medication, the loss of trust between doctor and patient. (Hmmm, hey PharmSteve…….red flagged by PDMP, what does that mean and how does it apply. And is it legal to make a daughter suffer even if the father DID doctor shop? Now that would make for an interesting and useful thread)

      *For any questions concerning the legal definition of doctor shopping please see this link below by the Florida Dept of Law Enforcement:

      http://www.fdle.state.fl.us/Content/getdoc/f617ed03-1c84-4cb4-9f65-c4ae020bb112/11-01–Doctor-Shopping-Statute.aspx

      Doctor Shopping Statute
      Case: Knipp v. State, 35 FLW D2898a

      Date: December 22, 2010

      Subject: “Doctor Shopping” statute is violated when a patient seeks a prescription and then fails to inform the doctor that he or she has already obtained a prescription for the same or similar controlled substance within the last 30 days, EVEN IF the doctor did not specifically ask the patient whether they had done so

      FACTS: The defendant, Jeremy Knipp, obtained a prescription from a physician, and within thirty days of obtaining the first prescription, obtained another prescription for the same controlled substance from a different physician without informing the second doctor of the first visit.”

      There is nothing saying a patient cannot see every single neurologist, rheumatologist, or orthopedic doctor in the state of FL. Trying to find a qualified doctor for someone who is disabled is a necessary process of elimination, not ‘doctor shopping’. Example.
      Doctor #1 may dismiss your symptoms and places little if any value on your input when making final treatment decisions, which you as a patient have to live with, not the doctor.
      Doctor #2 may wish to take a wait and see approach to your ‘disease/injury’ for now. You disagree and tell him/her you need care and soon, whether it is a surgery, medication therapy, or another avenue, as you have suffered long enough and need relief and some QOL. If you had a treatment regimen that was working well for you before you moved to FL and don’t feel there is a need for a change you can feel free to move on and seek another doctor. (I wouldn’t take my dog back to some of the clowns I have seen in my 15 yrs w/ AI disease),
      Doctor #3 agrees w/ the treatment plan you had arrived at with your former doctor in your former state of residence and continues it either verbatim or with slight modifications. You wind up staying w/ #3. This is not ”doctor shopping”.

      *Maybe Steve can weigh in on this topic with separate thread at some point (or maybe direct us to one that is already up that we may have missed). There seems to be much confusion about what doctor shopping actually entails.
      Doctors are not volunteers, it is their profession, their job. If you are not satisfied w/ their work you fire them and move on, simple as that, just like a mechanic that never could fix your car but still charged you for repairs, why would you return?

      As far as prescriptions overlapping? This should not be a problem as long as the doctors who are writing the prescriptions are aware of it and both approve of the treatment plan. Be honest and upfront about what medications you are currently taking. I attend a reputable pain management clinic and am presently prescribed hydrocodone (BT pain). In first 3 yrs of PM I never needed ‘extra pain meds’. This year I have on 2 occasions for pain and once again for uncontrolled bronchospasms (cough medicine).

      This is just MY EXPERIENCE. I informed my PM doctor last Dec that I required throat surgery (Jan ’14) and what asked would we do if I required extra pain medication. She told me to let the surgeon write for any extra medications if needed and let him know every medication that I am currently taking. In Oct I informed PM doc #2 [replaced PM #1 after she left practice] that I again required surgery and how would we handle it if/when I needed extra pain medication. He told me basically the same thing, let the surgeon handle the post-op meds. I brought in my discharge instructions, Rx bottles, and follow up consult notes for documentation and verification and there was never a problem. It was duly placed in my records (I’ve seen the entries). I was prescribed hydrocodone for both surgeries while I had an active Rx for hydrocodone at the time from my PM doctor. I told the pharmacist upon turning in my Rx that if there was any trouble to please contact the pain management clinic and they could straighten out any questions they had. (Was NOT present when Rx was presented for throat surgery but that is another thread in and of itself)

      I do not receive enough opioids from my PM doctor to suppress the type of chronic uncontrolled coughing/bronchospasms I get at times when I add bronchitis to my asthma and ILD. It can and has led to two medical emergencies due to uncontrolled bronchial spasms,inflammation, and air passages blocked w/ sputum. I officially stopped breathing from this complication in 2000 but made it to hospital in time and was admitted.
      This time I didn’t let it get that far, though it was scary enough for me to go to ER. I do NOT go to ER EVER. Afterwards I brought in ER discharge orders and consult notes from my pulmonologist stating that an Rx for Tussionex was a medical necessity until my situation had settled down. (I had already been given two weeks to get ‘over it’ or she said she was going to admit me to hospital for IV antibiotics and pulse steroids).

      Long winded version but just wanted to show from experience it’s not a death sentence having two doctors write for the same scheduled medication even if they DO overlap. There are situations that require one to receive extra medication. If the medications the surgeon, pulmonolgist, etc, is familiar and comfortable with then this may happen. Why penalize the patient? Also it is not always feasible for the PM doctor to be the only prescriber for a patient’s controlled meds especially for disabled patients that at times need urgent attention. Just be upfront about everything. Try to work out the details beforehand. My guess is this doctor that says your husband is ‘flagged’ is missing a pair and is just too scared to write scheduled medications even when it is clearly necessary.

      • Hi Coonhound, I will elaborate on my post (first I’d like to state that there were not multiple rxs from multiple docd!)…..after moving here in April, my hubbie saw a dentist for 3 months to take care of several issues. Most appts resulted in a great deal of pain so the dentist would prescribe 25 lortab with 1 refill. After all dental issues were taken care of, my hubbie went for new patient appt with my neuro/PM Dr. Approximately 3 months later I took my daughter to dentist because of toothache. He cleaned and filled tooth. He prescribed 25 lortabs and antibiotic. Pain persisted, so I took her bk to discuss the situation. That’s wen I was told about flag on my hubbie. I know he wasn’t lying to me nor was he concerned about being investigated.. About 3 weeks ago I figured out why he did wat he did. It was my turn to have dental work. I had 3 teeth yanked. I never said a word about being in pain, even though I was a lil worried my 4 painkillers per day I get from pm wouldn’t be enuf while I healed. I was handed 2 RX’s – one for lortab, other for erythromyacine. He knows I have a pm Dr. (Btw , I called my doc the day of dental appt to let him know I was having oral surgery and ask wat to do should I receive an RX.) I believe the dentist was testing my husband and myself. Had I become angry and cancelled all future appts for my family or neglected to mention my pain contract, I would look like a seeker. Side note: pm was concerned about pharm flagging me, I was worried also. The pharm warned me not to take more than 2 lortabs with my 4 percs. She completely understood my situation. As it turned out, I only needed 11 lortabs total. Now wen I go bk to have more extractions, I won’t need an RX.

  12. I have been making comments about what is commonly termed the “Pharmacist Manual” or the federal pharmacy regulations Title 21 USC. This title is refered to in many state pharmacy laws which state that the federal regulations comply with the state statutes and therefore are prevailing. In many state laws I have read that those states have passed additional laws concerning pharmacies relevant to that state only. In Florida, I have problem with the way pharmacist’s seem to believe they have a unilateral right to refuse a prescription. I find no place in either the Federal Pharmacy Act or chapter 465 of the Florida statues which provide this right except when dealing with an out of state provider. What I have read only requires a pharmacist to properly verify both the elements of the prescription (specified in chapter 465) and the legitimate medical purpose of the medicatiton prescribed. This is required of all pharmacist’s filling prescriptions, however if a pharmacist decides not to fill a prescription he must be making the determination that there is something wrong with the prescription. If not it should be verified and filled. If there is reason to suspect the prescription is not valid then Florida law makes it a 1rst degree misdemeanor to not report the incident with a copy of all submitted docments, to the sheriff within 24 hours (FS465.015(3)). If all these pharmacist’s really belive that the prescriptions they are refusing are not legitimate they are violating the law by not reporting them. I suggest that all of us legitimate pain managment patients insist on the pharmacist reporting us if they are refusing to fill our prescriptions. Then we will get our chance to submit our medical history and prescription history in court. If the sheriff finds no reason for the refusal in his investigation then I would think a good attorney is in order and I think the pharmacist’s would get the message not to refuse verifiable legitimate prescriptions or they will have to defend their decision in court every time. In the event your pharmacist does refuse your prescription and it is legitimate then insist on him reporting the event as per the law. Then when it is found to be legitimate use the investigation report to “take them off at the knees”. Please if you do not believe this post read the Florida statutes chapter 465 and you will see for yourself that these pharmacist’s that refuse to fill a prescription and do not report it to the sheriff within 24 hours are guilty of a violation.

  13. Well here’s another complaint(s) in the pipeline. I just started the complaint/grievance process Mon. for an incident that occurred on Friday Nov 7th (problem started in April).

    Back in April after filling my Rx(s) at Baptist Medical Center since 2009 w/ no troubles, I hit a snag. BMC has 7 pharmacies in Jacksonville FL and its immediate surroundings and ALL are open to the general public. I took my scripts to the main hospital pharmacy like usual and was told I could not fill it there that I had to use their pharmacy located in the building where it was written (hint not every building has its own pharmacy, details later). The pharmacist at that location (2 blocks away) said they weren’t taking ‘new’ patients so she couldn’t help me. After much back and forth I was ‘allowed’ to fill my Rx at the main hospital pharmacy, this time, but they wouldn’t be able to accommodate me in the future.

    At this time I called patient services and eventually spoke with a patient advocate. She directed me to Janice Rodgers the director of outpatient pharmacies for BMC.
    After giving her my story she said she would speak w/ the pharmacists and get back w/ me. 3-4 days prior to my doctor appt and Rx running out I had still not heard back from her despite leaving several messages expressing my concern w/ my Rx running out and the issue still unresolved. I finally got ahold of her by calling her assistant. Interestingly enough she was right there on my first call and available so she put me right through! Coincidence I guess, eyes roll. I was given a litany of reasons why they could not help me.

    1-I was from ‘out of state’ which should not have been a valid excuse because BMCs has 4 pillars of care stated right on their website. Pillar 3 states their community focus.[quote]
    “We exist for ONE reason: to serve the healthcare needs of people in the NE FL AND SOUTHEAST GEORGIA. (I live in SE GA and have since I was first seen by their Rheumatology Dept in Oct 2oo9).

    2-The Pain Clinic was technically not staffed by official Baptist Doctors.
    I pointed out that they were profiled on their website, affiliated w/ the hospital, located on the BMC campus, and I was referred there by my doctor at BMC Rheumatology Dept and no problems were ever pointed out in regards to this technicality in the previous 4 yrs.

    Several other ‘problems’ were mentioned such as making sure the hospitals patients had access to the med in question for surgery. I told her that this med was not for use in surgery according the printouts given and if it was it would be very rare situation. She reluctantly agreed w/ me and told me the DEA was watching everyone like hawks…..long story short,after much cajoling, pleading, threatening, etc, etc I was ‘awarded’ the privilege of filling my Rx at the one pharmacy located in the same building as my rheumatologist and pain management doctors but not ANY of their other pharmacies. If they were out of stock then it was too bad can’t help you.

    I had filled my Rx at the Reid Bldng pharmacy from May-Oct w/ no problems. Nov 7th was told that they were out of methadone but would most likely have more in by Mon. I reminded them that I live in GA and it is an hour and a half one way so could they please call the main hospital pharmacy and see if they had any to save me the trip. (I am officially disabled on SSDI, use Medicare and suffer from lupus overlap/MCTD & systemic sarcoidosis. These cause me to have chronic anemia, sleep apnea, iron deficiency, hypothyroid, GI motility issues and other symptoms that all cause fatigue and the trip takes alot out of me).
    The PIC refused to call and check and said they would not 1-tell her if they had any and 2-would not fill for me if they did.

    I took my Rx to the main hospital pharmacy. I was denied a fill. When I asked the reason I was directed to the PIC Michael Brooks. He proceeded to tell me that he would not fill my Rx because they only filled for Doctors located in the main hospital and that the DEA limited the number of pills he could get each month.

    I reminded him that his pharmacy was open to the public and even if it wasn’t that it was a heck of a way to inconvenience someone who had been a patient of their Medical Center of over 5yrs. He said it was a hospital rule.(he would fill others but not Schedule II). I told him that he was under contract w/ BC/BS medicare part D and he could not pick and choose which Rx he wished to fill there. I showed him my formulary and Evidence of Coverage booklet from BC/BS but he was not interested in looking at it. I asked him again if this was the story he was sticking to and he said yes. I told him I was going to file a complaint w/ BMC, BC/BS, CMS, FL BOP, just for starters. He was non impressed. I attempted to show him this section in the evidence of coverage

    Pg 26 Section 2.1 states the following:
    A network pharmacy is a pharmacy that has a contract with the plan to provide prescription drugs. The term ‘covered drugs’ means ALL of the Part D prescription drugs that are covered on the plans Drug List.
    Section 2.2 states:
    You may go to ANY of our network pharmacies. Choose whatever is easiest for you.

    I called BMC patient services Tuesday but have yet to receive a return phone call. I told rep I did not want to be directed to their pharmacy dept as this has gotten me nowhere and they was the root of the problem. I am just getting over the flu this week so I have not pursued it further but will call again MON.

    I called BC/BS customer service Tue after speaking w/ BMC. I informed the rep of all that I just shared. Throughout the conversation the rep reminded me that certain pharmacies have different rules and procedures and that there was alot of issues w/ ‘these’ medications at the moment. Towards the end of talking to Ms Stone Wall she tells me I can fill out a grievance form! At this point, flabbergasted, I say what have I been doing for the past 20 minutes?!?! I said that I had their Evidence of Coverage booklet outlining the complaint/grievance process right in front of me and it clearly states CONTACT US PROMPTLY EITHER BY PHONE OR IN WRITING.
    I told her that I was not receiving satisfaction and outlined to her that I pay a premium to her company to provide me the service of filling my prescriptions w/ one of their contracted pharmacies. If the pharmacy does not uphold their contract that this is fraud and I would be contacting CMS. Also added that to fill a med for blood pressure but not pain was discrimination under the ADA and I would not accept being treated this way.

    With both of these calls I stressed that the printout for this med stated that it should not be stopped abruptly (day 32 on a 30 day fill was Fri) and w/ my health it could prove fatal. They didn’t seem all that impressed.

    This must have got her attention as I was told (not asked) to hold while she ‘found’ a supervisor’.
    Mr Supervisor came on and went over what the rep relayed to him. He says well it looks like you got it filled Sat. (like everything should be cool now right?) I told him yes I did and it was no thanks to anyone w/ his company or BMC and my complaints were still valid and would be pursued to the fullest. Told him that I did not enjoy driving another 30 min to another pharmacy after a long day the day before waiting an hour on the Rx then driving back another 30 min home. He said if I still wished to file a grievance that one would be filed on my behalf. STILL WISHED TO FILE A GRIEVANCE? WTH DOES IT TAKE TO GET THROUGH TO THESE MOPES THAT THAT IS WHAT I AM DOING w/ this phone call, HELLO ANYONE HOME!!! Light bulb flashing here-everything they have done and said has been to minimize my complaint, get me to not file an ‘OFFICIAL’ complaint, or to accept ANY responsibility for inconveniencing me or putting my health in jeopardy. Was told it I would hear back from BC/BS w/in 30 days.

    This is the start. Due to flu (projectile vomiting as sport) I was unable to do much of anything this week until today. Next step is call to CMS then ADA then FL BOP and whatever and whoever else I can think of or be pointed in the direction to because they have F’d w/ the wrong guy this time. I think if everyone who is denied their medication would follow these steps here (thanks to you steve you are an invaluable asset to the disabled citizens across this once great country) we would be out of this hole in no time flat. Writing to your congressman is a first step but apparently worthless as I have done this as have many other. Petitions? Been there signed them. Shared on blogs, this one and many others, patient support sites? ditto……..I can’t seem to get many people involved. Once the ‘vent’ they ‘feel better’ and act like this is like some cathartic exercise, unbelievable the apathy among citizens today. I can see it and understand it when it doesn’t affect them directly as we live in a fast paced dog eat dog society but when it affects you directly and you still sit there and do nothing I am at a loss. If this continues we will have nothing to lose.

    Why is everyone just content to stay on the sidelines and hope for the best? Read this below and tell me what you think cuz its only gunna get worse ESP for the DISABLED.
    *The information below [the portion in quotes] and more can be found @ http://www.hematology.org/Advocacy/Policy-News/2014/3300.aspx

    Question-Did pharmacy crawling searching for one to fill your RX make you use more than 3 pharmacies to fill your opioid pain meds in a calendar year?
    The Medicare Payment Advisory Commission (MedPAC) advises a solution to curb opioid abuse by patients w/ Medicare Part D. Their data mining showed…..

    *”the top 5% of opioid users……………..on average, fill twenty-three opioid prescriptions per year……31% fill prescriptions at three or more pharmacies.. At-risk patients could be locked-in to single prescribers, or a single PHARMACY could be locked-in to distribute all opioids within a geographic area (e.g., a state)…..While these policies might prevent opioid abuse, they could burden physicians and patients by limiting access to pharmacies for legitimate opioid use”

    uuuuuuummmmm YA THINK? HELLO! I’m I the only one that feels like a pebble of sand in a sand castle w/ high tide coming in fast?

    The best defense is a good offense. We need an all out blitz NOW or this is issue and our quality of life is finished. The ONLY thing that gets these a-holes attention is legal accountability and dollar signs$$$$. SO….come on guys let’s get after these MFkrs! Lodge complaints and grievances for any and everything you can in regards to your rights and medications. They have been up our ass for WAY too long.

    Coonhound

    • You might as well forget the grievance procedure through CMS (Medicare) because they now try to get you to file through your insurance company. I have now filed 4 grievances against my insurance plan by my insurance plan and have not even received a response. I have called the plan and been told that all of the grievances are pending. How can they delay the 30 day rule in their handbook for responding to grievances for what is now almost 6 months? Apparently, CMS is overwhelmed with complaints and no longer is able to handle them.

      • Sorry you have had such a hard time w/ the grievance procedure. The CMS rep told me the same, that I should receive benefits and if I don’t I need to contact my insurance company. You need to bypass the min wage rep and demand a supervisor at the bare minimum then go to CMS and do the same thing bypass/demand.

        I do have an update in regards to how my grievance procedure is going (or not going) that is rather interesting in light of what you are sharing in your post. On Dec 18 I had still not heard back from BC/BS PDP regarding my grievance which was now the >30days they guaranteed.
        So. I called CMS. The rep was a joke but the supervisor I talked to took down all my information and commented that she thought I had a clear case of more than one violation w/ both the insurance company and the medical center’s pharmacies. While waiting on their computer to go through its motions there was a bit of down time. I told her that I kept up w/ all the goings on w/ the prescription drug ‘epidemic’ and the resulting patient abandonment and pharmacy refusals.
        I commented that they must get these complaints all the time. She told me that this was actually the FIRST complaint she had received that was against a pharmacist!!!

        Keep in mind that this was a SUPERVISOR w/ CMS; and in Dec ’14 she was processing her FIRST grievance against a PHARMACIST for refusal to fill and therefor in violation of contract w/ Medicare Part D provider?!?!?!? Unreal. Almost a direct contradiction to your experience.

        Interestingly enough I received a call back from BC/BS Part D rep not 2 days after filing complaint w/ CMS, coincidence? No, she left message saying it was in regards to the complaint. So ignore til it goes ‘higher up’ must be their strategy. I Spoke w/ her on Dec 23 for an hour. She continually made excuses for the pharmacies in the medical center’s network then went on to suggest that I change to a doctor closer to home!!!!!!

        I then read verbatim from their Evidence of Coverage booklet in which they claim, and repeated in their booklet ‘Annual Notice of Changes’, that say and I’ll quote:

        “The Evidence of Coverage is the LEGAL, detailed description of your plan benefits. It explains rights and rules you need to follow to get covered services and prescription drugs”
        She told me that there were a lot of ‘problems’ and that the hospital had ‘regulations’ blah blah blah…..I then read another section…….
        and I’ll quote it “The Evidence of Coverage and applicable riders attached hereto , and completed enrollment form, constitute the ENTIRE CONTRACT between the parties and as of the effective date hereof, SUPERSEDE ALL OTHER AGREEMENTS between the parties”

        Seems pretty cut and dry and that is why I imagine she then asked me if I would participate in a 3 way call between her, myself, and the PIC at the pharmacy. Stonewalled by dunce PIC and when asked about the specific ‘regs’ that limited me to use of one out of seven of the medical center’s pharmacies he said he could not divulge any information!!!! Not a surprise as I have asked several times where I can find this information in writing and been denied. My guess is it doesn’t exist. After the call the rep promised to call the director of pharmacy for the medical center who set up this ingenious plan of limiting my rights that I pay a premium to receive and am being denied. But as of yet, no call back from insurance company but did receive a call from the director of pharmacy at the medical center the day before Thanksgiving. I went over all the same points of contention and received the same stonewalling towards the end of a 2o min or so conversation she asked when my next apt was. I told her it was on Dec, 8. My Rx was filled that day but WITH A 2 HOUR WAIT, never had to wait more than 1 hr prior to this time. This DID coincided w/ hitting I-95 rush hour perfectly though.

        To end this I cannot say how disappointed I am in being put off despite pointing out direct and seemingly in controversial proof of my rights under Medicare Part D being violated, and secondly the apathy of those patients out there who are taking it on the chin and do not fight back. We cannot wait for ‘something’. I don’t need to tell anyone here this but still, I am continually dumbfounded by all the comments on advocacy sites and comments sections following news columns and online news clips that say why isn’t someone doing something about this?!?! HELLO, STEP UP TO THE PLATE FOR CHRISAKE.

        I am still in disbelief. I don’t expect much from an insurance company as I was in litigation w/ one for 4 years to get a settlement over an auto accident that their client was clearly at fault BUT over rights for the disabled, supposedly backed up by the Federal Govt? If I dont receive some satisfaction, and I am not one for big conspiracy theories, but am left w/ nothing more than the idea that there has got to be some kind of collusion going on here to shut down treatment of pain. Possibly as part of an overall reduction in spending in regards to medical care. I have witnessed this in having to fight for 7-8 other medications, most NOT controlled, that are listed in my formulary,but I have been denied coverage for. Eventually they have been approved but not w/out spending hours on the phone w/ doctors, pharmacies, insurance company myself, not to mention the paperwork the doctors must fill out.

        IF anyone has any success stories about their grievance procedure I would love to hear it as at this point I am thinking I have just made myself a target and will have a harder time getting meds now than ever. I go for my next appointment and attempt to fill on Monday so hopefully all will go well. I shall give an update on this thread once I hear back from CMS,

        Coonhound

  14. 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

    Reply

  15. Where do we go to file a compliant here in Florida ? Is there a phone number or website ?

  16. […] Taking them off at the knees ! PHARMACIST STEVE – Thank you, Steve. Guess I’ve joined the chronic pain category after recent surgery. My bladder tore and started bleeding badly during a cyscosopy. […]

  17. […] Taking them off at the knees ! PHARMACIST STEVE – Way to GO Steve! Thank you very much! Your helping so many people! It’s really great! I hope we beat this soon with going after the ADA violations !! […]

  18. Where do we start here to oppose the DEA guidelines? This is an unconscionable travesty. I underwent major surgery and was given about 15 norco. I could not understand why I was so badly under treated for pain. My husband took me to the ER in acute pain and I was told they “don’t dispense narcotics.” So I was left to writhe in pain like some dark medieval torture horror movie – only it was real, and it was happening to me. I went home from the ER and cried – I was confused. Then – I researched and learned about everyone else experiencing the same thing. It made me LIVID.

  19. The ADA is worthless. Tried them. They did nothing – another worthless government agency.

  20. Get with the program – government agencies are useless. THESE people do NOTHING all day. Haven’t ANY of you worked with or in a government office???

    The ONLY chance we have is to have a huge demonstration and invite the press. We have to create our OWN organization and become a force to be reckoned with.

    We are dealing with callous, soulless psychopaths. I’ve dealt with these people – you can NOT reason with them.

    FORGET THE USELESS DEA AND FOCUS ON DEVELOPING OUR OWN ORGANIZATION OR YOU CAN KISS THE QUALITY OF YOUR LIFE GOODBYE.

  21. love this page, I recently was red flagged or supposedly for asking about an alternate generic for my anxiety medicine, two pharmacists said that it was something that they do and then when put on the phone with a third he said this was highly illegal, tired of being treated like a junkie

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