Could the Amazon Pharmacy prevent pts who have a valid medical necessity for controlled substances from getting their meds ? – UPDATED

For numerous years the DEA has “forced/persuaded” the pharmacy wholesalers to RATION controlled substances that a community pharmacy can purchase.  That rationing is based on a PERCENT of all the Rx meds that a particular pharmacy purchases… I have seen rates of 15%-20% being thrown out as the limit of controls that a pharmacy can purchase.

Several of the statements/press releases that has been put out by Amazon over the past 1-2 weeks… have had some vague statements as to what they are intending to do.  One of their statements was to push the issue that they believe that they can sell pts medications for less than their insurance copay.

They also said that they would inventory “common prescribed medications”… since controlled substances are typically 15%-20% of all prescriptions – will they be considered “commonly prescribed medications ” Just think of all the potential headaches of dealing with the DEA that they would avoid if they don’t dispense controlled meds ?

Just like pain clinics wants to only do ESI’s on pts so that they are not dealing with controlled substances.

If people start having their non-controlled meds filled at the Amazon mail order pharmacy, that means that the local community pharmacist will be purchasing fewer non-controlled Rx meds and most likely the DEA will reduce their ability to purchase the amount of controlled substances as they have in the past.

Could this produce a larger “out of stock” issue by local pharmacies for controlled substances and/or if the local pharmacies are even able to retain enough overall Rx business to remain profitable enough to remain in business.

The vast majority of controlled substances are prescribed to pts who are dealing with subjective diseases (Pain, Anxiety, Depression, Mental Health & ADD/ADHD). The total number of pts that could be affected could be a HUGE NUMBER.

As fewer and fewer controlled meds being distributed by pharma wholesalers, will this just encourage the DEA to cut pharma production quotas on controlled meds even that much more ?

Could this end up causing a whole lot of collateral damage to those pts with a valid medical need for controlled substances that NO ONE WILL CARE ABOUT ?

UPDATE

We do not deliver Schedule II controlled medications, which includes most opioids. Learn more at amazon.com/pharmacy.

I have been using that Walgreens, for the past 4 months, pharmacist would not fill my prescription, because my dose was doubled

Hello Steven

I was very impressed with the article that I just read .  I am having that problem with a Walgreens store located in Indialantic Florida 32903 Highway A1A and Paradise Boulevard. I have been using that Walgreens store where I have been filling my chronic pain medicine hydromorphone (4 mg) for the past 4 months and before that I was with them for years  The pharmacist would not fill my prescription based on the fact that it was increased from 4 mg to 8 mg 3 times a day 90 tablets.  I had to wait 4 days until I found another Pharmacy to fill my prescription and therefore was without my pain medication.  The reason other pharmacies did not want to fill it is because on record I am a patient using Walgreens pharmacy. and I should not be using different pharmacies.   I just went to the doctor and have the same prescription that’s why I  hope you might be able to help me. It is due to be filled on the 27th of this month.

I have already contacted the corporate office  and filed a complaint approximately 2 weeks ago I still have yet to hear back.  Any suggestion on how I am supposed to get my new prescription filled?  Unfortunately I cannot go back to the pharmacy Care Plus Pharmacy in Sebastian Florida.  This is where I finally got my script filled from last month. The reason being they called me about a week after they filled it and said they did not realize I was in Brevard County and their Pharmacy is located in Indian River County even though the pharmacy it’s about 20 miles from my house
I would highly appreciate your help in resolving this matter so I can have my medication that I so much need.  I am also disabled and have at least five other major illnesse.  For one a brain aneurysm so as you can probably imagine the stress of the situation is not good at all for my health
Thank you so much for taking the time to read my email
  Here is my response to this pt:

Here is a revised Pharmacy practice act that went into effect Dec 2015 and basically Pharmacists are not suppose to start looking for a reason to refuse to fill a prescription   https://floridaspharmacy.gov/latest-news/validate-pain-medication-prescriptions/

In filling these prescriptions, the Board does not expect pharmacists to take any specific action beyond exercising sound professional judgment. Pharmacists should not fear disciplinary action from the Board or other regulatory or enforcement agencies for dispensing controlled substances for a legitimate medical purpose in the usual course of professional practice. Every patient’s situation is unique and prescriptions for controlled substances shall be reviewed with each patient’s unique situation in mind. Pharmacists shall attempt to work with the patient and the prescriber to assist in determining the validity of the prescription.

unfortunately, I’m not aware of any action the FL Board of Pharmacy (BOP) against any pharmacist that has denied care … as you have experienced  here is a link to file a complaint with the BOP  https://mqa-flhealthcomplaint.doh.state.fl.us/

The DEA has claimed that a pt traveling a long distance to get a controlled Rx filled is a RED FLAG.. . because that is what substance abusers/addicts/diverters do…  I heard one story years ago a chain pharmacist refused to fill a controlled Rx for a pt that lived in a different zip code that the pharmacy … but… the pt only lived about 1/2 mile from the store but there was a zip code boundary line between the pt’s home and the chain pharmacy.

My suggestion is to find yourself a independent pharmacy where you will be dealing with the pharmacist/owner  here is link to find one by zip code  https://ncpa.org/pharmacy-locator

go talk to the pharmacist/owner and talk about moving all your Rxs to them… talk to them about syncing up all your meds so that they are all filled on the same day each month.. everyone saves time and trouble.

I wouldn’t hold your breath on getting a response from Walgreen corporate… we have a serious and growing pharmacist surplus and if they were unhappy with how a pharmacist was treating their pts.. they would get rid of them… just yesterday I posted a article on how the surplus is so bad that for every 3  new pharmacists grads… ONE may be able to find a job — and do not count on it being FULL TIME.  IMO,  Walgreen’s lack of response SPEAKS VOLUMES about how much they care about chronic pain pts getting their medically necessary medications and/or being thrown into cold turkey withdrawal.

Finding a independent pharmacy may be the quickest route to help you deal with your health issues.  every other entity that you can complain to will drag their feet and you will be lucky to hear from them within 12 months.

One final point is that one of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy – that Walgreen pharmacist basically changed your therapy – refused to follow physician owners… you might find some relief by filing a complaint with the FL medical licensing board… for the Pharmacist practicing medicine without a license.

Every chain pharmacy is understaffed, techs are underpaid. Pharmacists are overwhelmed

As a retail pharmacist for 18 yrs with a massive company. I would highly recommend that anyone who can, transfer their prescriptions to a local independent pharmacy

The brick and mortar chains are cheating customers and employees, while earning a windfall of cash for the executives only.

Every store is understaffed, techs are underpaid. Pharmacists are overwhelmed.

Demand better healthcare!


Pharmacist Job Outlook: It’s Worse than You Thought studentloanplanner.com/pharmacist-job At a minimum, it seems as if a net 10,000 pharmacists will be entering the labor force yearly with nowhere to go


CVS: The pharmacy was 1,200 scripts behind and eight days behind in prescription refills


 

I have read statements from numerous statements from numerous chain pharmacists that typically pharmacist’s shift is from opening to close – normally some 12-13 hr shifts and when they leave at the end of their shift..there is still a few hundred UNFILLED Rxs left in the computer que that was not filled by the end of the day.

I have read from pt statements that when they come to pick up their Rxs after calling in a refill a few days before and it is still not ready and when they do finally get their refill.. the date on the Rx label can be a few days before they tried to pick up their Rx and it was not filled.   Not to justify a such lag time … it could be done so that if a prescriber has to be contacted regarding a refill with no authorized refills left … that process can be initiated and/or if the pharmacy computer system auto replenishes inventory… that would help assure that the needed medication can be in stock… when the Rx finally gets to be filled.

Historically, there has always been what is called a PIC ( Pharmacist in Charge) who is responsible to the state’s board of pharmacy for the legal operation of the Rx dept that they are listed as PIC.  Back when these designations were developed into a pharmacy practice act, the vast majority of pharmacies were independent pharmacy… so the PIC was typically the pharmacy owner.

Some states have changed this designation from PIC to “responsible pharmacist”… and since chain pharmacies dominate the market place… the pharmacist that is responsible to the state’s board of pharmacy for the legal operation of the Rx dept … is now responsible for everything and IN CHARGE OF NOTHING… just the way the corporate management of chain pharmacies likes it.

When a pt patronizes a independent pharmacy… typically they are dealing with the Pharmacist/owner and often the tech staff has been there for years… because the Rx dept is well staffed and the staff is well paid.  We had our own independent pharmacy for 20 yrs and when we sold out to a chain… my primary tech had been with us at least 12 yrs and they said that they would keep her hourly rate and benefits and was told that she was going to be the HIGHEST PAID TECH in the entire chain pharmacy and this chain was in the top 5 in the USA as far as the number of stores that they had.

It is YOUR HEALTH…. It is YOUR LIFE…. It is YOUR CHOICE …. chose wisely !!!

Five lawmakers demands for the DEA to double down on its policy of limiting pain patients’ access to their medication.

Are these FIVE LEGISLATORS proposing a bill that would cause the DEA and other agencies/entities to discriminate against all pain pts – including those with intractable chronic pain  – that would be a civil rights violation of both the American with Disability Act & Civil Rights Act ?  Does this make this proposed bill UNCONSTITUTIONAL before it even gets a vote to pass ?

Elizabeth Warren Advocates to Formalize Barriers for Pain Patients

https://filtermag.org/elizabeth-warren-partial-refills/

Five lawmakers, including Senator Elizabeth Warren, have renewed their demands for the DEA to double down on its policy of limiting pain patients’ access to their medication. Their position is premised on a misunderstanding of the ever-worsening overdose crisis—which is currently driven by an illicit heroin and stimulant supply adulterated by the synthetic opioid, fentanyl.

In an October 6 letter to acting DEA Administrator Timothy Shea that is almost exactly the same as one from July 2018, Sen. Warren, who has a track record of supporting harm reduction services, called on the drug-war agency to update the agency’s medication “partial fill” regulation to clarify that pharmacists can voluntarily withhold some of an opioid prescription, as advised by the patient’s prescriber. Patients can also request them.

The bipartisan Comprehensive Addiction and Recovery Act (CARA) of 2016 authorized these partial fills of Schedule II controlled substances when pharmacists are “unable to supply the full quantity.” This was an attempt, the bill states, to “address the prescription opioid abuse and heroin use crisis” by cutting patients’ access to medications. But due to the DEA’s “foot dragging,” as the five politicians describe it, part of the legislation remains unimplemented

“We can’t afford to neglect the opioid epidemic, nor the communities it is affecting the most, while we continue to combat COVID-19,” wrote Senator Warren in an op-ed published by a local Massachusetts newspaper less than a week before her latest letter to the DEA.

But her advocacy in the name of people who use opioids may have mixed results for their wellbeing. Warren’s press team did not respond to Filter‘s request for comment.

Opioid analgesics can be crucial for pain patients’ mental and physical wellbeing, and partial fills may function as a type of harm reduction support. “If someone’s having trouble controlling their medication, it’s a good thing,” pain patient advocate Anne Fuqua told Filter. The current accepted use of partial fills for when pharmacists run out of a medication is also beneficial to patients, she added. “If my pharmacy is out, I’d have to wait or forfeit [my prescription]. You’d have to get a second prescription and some doctors don’t care.”

On the flip side, for Fuqua, partial fills could make pain patients’ lives more difficult. “If the doctor writes a script for once a month but you have to pick it up every week, that would be a tremendous burden.”

They therefore risk adding one more barrier for patients who have already been harmed by other prohibitionist attempts at getting a handle on the overdose crisis. “Clinicians might universally stop prescribing opioids, even in situations in which the benefits might outweigh their risks,” the Centers for Disease Control and Prevention (CDC) wrote in a 2017 commentary. “Such actions disregard messages emphasized in the guideline that clinicians should not dismiss patients from care, which can adversely affect patient safety, could represent patient abandonment, and can result in missed opportunities to provide potentially lifesaving information and treatment.”

Politicians’ fixation on the prescription opioid supply further misses what is driving record-breaking, preventable overdose deaths—especially among poor communities and communities of color, both of whom have been made vulnerable to drug-related harms by the federal governments’ austere health policy.

Deaths involving cocaine and methamphetamine reportedly surpassed those of most opioids for the first-time in August 2019, an apparent turning point in the nature of the drug-involved deaths crisis in the United States. The latest CDC data show that, in the last month of that summer, more people’s predicted deaths involved cocaine (15,206) and/or “psychostimulants with abuse potential” (15,180)—a vague category that includes crystal meth—than those involving heroin (14,674), “natural & semi-synthetic opioids” (12,093), meaning opioid analgesics, and/or methadone (2,849) combined.

Black Americans who use cocaine are disproportionately likely to die from an overdose or overamp. According to a September 2020 study, 11 percent of reported cocaine users are non-Hispanic Black, yet more than one-quarter (27 percent) of cocaine-related fatalities involved non-Hispanic Black people. In 2018, the non-Hispanic Black cocaine-involved death rate was twice that of whites, despite past-year cocaine use prevalence being about the same between the two groups.

The synthetic opioid fentanyl is playing a large part in the current overdose crisis too. As of February 2020, it was by far the most common substance involved in the historic death toll. But its supply is mostly through illicit markets, not patient diversion, as the DEA has reported.

Warren’s recent op-ed failed to recognize these trends. Instead, she continued to characterize the issue as an “opioid crisis” and made no mention of the role of stimulants. She did mention fentanyl, but only to say that pharmaceutical companies left people who use drugs “vulnerable to developing addictions to more dangerous and illicit substances like fentanyl.” While some people have come to prefer fentanyl (which doesn’t necessarily indicate addiction), many who experience its harms don’t know about its presence in their drugs.

Warren has worked to advance laws that hold greater promise for ending the crisis. In April 2018, she and the late Representative Elijah Cummings introduced the Comprehensive Addiction Resources Emergency (CARE) Act—a bill, yet to become law, that would provide to frontline interventions what CARA failed to: money. Billions in federal funds would go to bolstering hard-hit jurisdictions’ responses; advancing public health research and surveillance; supporting treatment, prevention, recovery and harm reduction; and expanding professional and public access to naloxone, the opioid overdose reversal medication.

 

Amazon opens online pharmacy, shaking up another industry- should healthcare remain locally ?

I have always had a concern about mail order pharmacies.. first of all… all medications have temp storage requirement typically in the mid-50’s to mid-70’s. These storage requirements have to be met by the pharma, wholesaler & the pharmacy.  But, when a pharmacy hands off a packaging of Rx meds to a delivery service… NO ONE has a obligation to maintain those storage requirement.   Normally, if a pharma, wholesaler, pharmacy allows Rx meds to be outside of the required temp range for > 24 hrs the product is consider adulterated and NO LONGER SALEABLE.

From this article and others that I have read, Amazon appears to be “pushing ” paying cash for Rxs.  If this Amazon pharmacy has a contract with your health insurance and you pay cash… it won’t applied to your deductible and highly possible if you submit your cash receipts to your insurance company they will not reimburse you and apply to your deductible because Amazon pharmacy has a contract to bill the insurance for the pt.

Encouraging pts to PAY CASH the Amazon pharmacy will not have to deal with the BS from insurance companies in getting a Rx claim thru the system and with a charge card .. Amazon will get their money in – at most – a couple of days instead of having to wait 2-3 weeks for the insurance company to pay and then reconcile their payment against what was billed and won’t get docked with those unpredictable DIR fees.

If this Amazon pharmacy functions like most mail order pharmacies, filled Rxs may not reach the pt for up to TWO WEEKS and what does their statement mean that theywill offer commonly prescribed medicationsDoes that mean NO CONTROLLED MEDS ?  The DEA states that it is RED FLAG for a pt to pay cash for a controlled substance if they have insurance.

 

Amazon opens online pharmacy, shaking up another industry

https://www.foxbusiness.com/retail/amazon-opens-online-pharmacy-shaking-up-another-industry

The company opened an online pharmacy Tuesday, giving Amazon shoppers the chance to buy their medication and order refills on their phones and have it delivered to their doorsteps in a couple of days, just like a book or toilet paper.

The move propels Amazon into a new business, potentially shaking up the pharmacy industry as it has done to everything from book sellers to toy stores and grocers. Big chains like CVS and Walgreens rely on their pharmacies to bring them a steady flow of shoppers who stop by frequently to pick up their medications.

Amazon said it will offer commonly prescribed medications starting Tuesday, including creams, pills, as well as medications that need to stay cold, like insulin.

Shoppers have to set up a profile on Amazon’s website and have doctors send prescriptions to the Seattle-based e-commerce giant.
ONLINE SHOPPING SURGE COULD LEAD TO HOLIDAY DELIVERY DELAYSMost insurance is accepted, Amazon said. But Prime members who don’t have insurance can also buy generic or brand name drugs from Amazon for a discount.Amazon has eyed the health care industry for some time. Two years ago, it spent $750 million to buy online pharmacy PillPack, which organizes medication in packets by what time and day they need to be taken. Amazon said that PillPack will continue, focusing on shipping medication to people with chronic conditions.

Apparently the COVID-19 didn’t get the memo about it being gone in a few weeks – this dated 04/2020

Stand and Fight Podcast – Darleen H. Palmer forced reduce dosages and SUICIDE

Click on the link below to listen to a 32 minute pod cast that details how a ultra fast metabolizer intractable chronic pain pt was forced to decrease his dose OVER 75% and he ended up committing suicide… evening behind a young wife with FOUR KIDS.

http://standandfight.buzzsprout.com/359756/2002150-stand-and-fight-podcast-darleen-h-palmer-pain-managment-vs-addiction

In this episode Darleen shares the story of her husband Adam. He caught a rare disease from a tick called Rocky mountain spotted fever which left him dependent on pain meds to function. The problem became dealing with the insurance companies and his struggle to find common ground with them. In the end her husband took his own life. Now she is her to tell his story and to help other families in need. She is now a single mother of 4. Sometimes we don’t think about the 1% who live with an insane amount of pain on a daily basis. They need medication just to function. Myself being a recovering addict i always fight for everyone to be drug free but this conversation helped me with the other patients who actually need it. A voice clip of the husband’s suicide goodbye message is on this podcast so if you are vulnerable or feel you might be triggered please don’t listen or listen with a friend.

Trial by Fire-CRPS documentary

RSD/CRPS is a condition that needs much attention. Charles saw this dire need and wanted to contribute to get that need filled. Charles has talked to many, heard scores of stories and researched the condition; with this knowledge, his heart was moved to get involved and become an advocate for the condition through the love of his mother and the heartfelt for the countless others suffering. This moving piece takes us on a journey that will impact the perspective of how we view healthcare and the caregivers of those suffering daily. We walk with Charles as he helps his mother through her own treatment and life changes. We will also meet others fighting to stay alive from this deadly disease. We will fight to help this project move the health care system to figure out ways to help those who need the funding or the health care coverage to get the needed treatment to allow them to live. We will expose what at times seems like Guinea pig-type of treatments that at times can do more harm than good. This is a story that needs to be told and this documentary will open the eyes of many around the world that never knew of this condition and bring hope to those with CRPS. For more info on Charles and his work visit. To work or book Charles visit http://charlesmattocks.com PLEASE SUBSCRIBE TO THE CHANNEL AS WE ARE LOOKING AT DOING ANOTHER FILM BASED ON CRPS AND RARE DISEASE, GET THE LATEST UPDATES. All rights and music belong to our company.

https://www.youtube.com/watch?v=5WZCh3TeTa0

What do you get when you have a national health emergency with a FOR PROFIT healthcare system ?

kaiser permanente: S CALF – If it involves controlled medication you won’t get diagnosed , they also lie on your chart and black ball you from all care of you switch DRs

I have Kaiser SoCal but prior to the last two years I had a private dr in Texas and took pain medication, 6 mg of Xanax & ambien for 7 years. No overdose no narcan required. I moved back to Ca after surviving a brutal attack now having anxiety so bad I am having psychogenic blackouts and the ambulance is coming to my job. Kaiser refuses to give me more than 2mg of Xanax even though it’s become physically dangerous s they also refuse to properly diagnose the blackouts as well as the very obvious adhd I’ve always had. If it involves controlled medication you won’t get diagnosed , they also lie on your chart and black ball you from all care of you switch DRs. I have fought them like crazy for proper care and they refuse to do anything stating I refused their treatment plan which is a lie. I already take gabapentin and have tried hydroxozine which is a joke for anxiety at my level, increased gabapentin is not going to stop the severe stress skyrocketing my cortisol and me passing out. I can’t believe there aren’t major groups fighting Kaiser for their horrific treatment.

I realize that not all readers of my blog read all the comments… but this is not the first time that I have received a similar comment – or email – from a pt that has health insurance from Kaiser Permanente telling about similar denial of care from them.

Kaiser Permanente is considered a HMO

Health Maintenance Organization (HMO)

and the definition of a HMO:

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

HMOs often provide integrated care and focus on prevention and wellness.

Does the care that this pt is claiming to be receiving has a focus on PREVENTION & WELLNESS ?

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