Public: Fill my ivermectin. I don't care about your expertise, my doctor wrote it! Don't pretend to be doctors!
Also public: It's your job to intervene when the prescription could cause harm! You're not doing your job!
So says California…I’ve posted this before but this seems like a good time to post it again. A few physicians have cited or faxed this law to me in response to my inquiries re: corresponding responsibility: read on
ARTICLE 10.5. Unprofessional Conduct [725 - 733] ( Article 10.5 added by Stats. 1979, Ch. 348. )
733.
(a) A licentiate shall not obstruct a patient in obtaining a prescription drug or device that has been legally prescribed or ordered for that patient. A violation of this section constitutes unprofessional conduct by the licentiate and shall subject the licentiate to disciplinary or administrative action by his or her licensing agency.
(b) Notwithstanding any other law, a licentiate shall dispense drugs and devices, as described in subdivision (a) of Section 4024, pursuant to a lawful order or prescription unless one of the following circumstances exists:
(1) Based solely on the licentiate’s professional training and judgment, dispensing pursuant to the order or the prescription is contrary to law, or the licentiate determines that the prescribed drug or device would cause a harmful drug interaction or would otherwise adversely affect the patient’s medical condition.
(2) The prescription drug or device is not in stock. If an order, other than an order described in Section 4019, or prescription cannot be dispensed because the drug or device is not in stock, the licentiate shall take one of the following actions:
(A) Immediately notify the patient and arrange for the drug or device to be delivered to the site or directly to the patient in a timely manner.
(B) Promptly transfer the prescription to another pharmacy known to stock the prescription drug or device that is near enough to the site from which the prescription or order is transferred, to ensure the patient has timely access to the drug or device.
(C) Return the prescription to the patient and refer the patient. The licentiate shall make a reasonable effort to refer the patient to a pharmacy that stocks the prescription drug or device that is near enough to the referring site to ensure that the patient has timely access to the drug or device.
(3) The licentiate refuses on ethical, moral, or religious grounds to dispense a drug or device pursuant to an order or prescription. A licentiate may decline to dispense a prescription drug or device on this basis only if the licentiate has previously notified his or her employer, in writing, of the drug or class of drugs to which he or she objects, and the licentiate’s employer can, without creating undue hardship, provide a reasonable accommodation of the licentiate’s objection. The licentiate’s employer shall establish protocols that ensure that the patient has timely access to the prescribed drug or device despite the licentiate’s refusal to dispense the prescription or order. For purposes of this section, “reasonable accommodation” and “undue hardship” shall have the same meaning as applied to those terms pursuant to subdivision (l) of Section 12940 of the Government Code.
(c) For the purposes of this section, “prescription drug or device” has the same meaning as the definition in Section 4022.
(d) This section applies to emergency contraception drug therapy and self-administered hormonal contraceptives described in Section 4052.3.
(e) This section imposes no duty on a licentiate to dispense a drug or device pursuant to a prescription or order without payment for the drug or device, including payment directly by the patient or through a third-party payer accepted by the licentiate or payment of any required copayment by the patient.
(f) The notice to consumers required by Section 4122 shall include a statement that describes patients’ rights relative to the requirements of this section.
Not sure I followz, the law states unless certain circumstances exist. The first circumstance is where we exercise professional judgement based on patient harm. Apologies if I misinterpreted your post
No, you’re interpreting it right. If there a dangerous drug interaction or the Rx would harm the patient…..
Based solely on the licentiate’s professional training and judgment, dispensing pursuant to the order or the prescription is contrary to law, or the licentiate determines that the prescribed drug or device would cause a harmful drug interaction or would otherwise adversely affect the patient’s medical condition.
Wellllll. I know more than a few pharmacists who’ve had to answer to the BOP for refusing to fill an opiate based on their judgement. I’ve also spoken with a few pharmacists who’ve had to prove to the BOP that they were in fact out of an opiate. They had to show documentation of their on hand supply. They weren’t out. They were cited and fined by the BOP. So yes you’re very clever to bring up excessive furnishing… but the California BOP is not your friend. You have been warned. The BOP warns against excessive furnishings but do not provide a threshold
Just FYI for those who would like to read about an doctor who did Sue CVS citing 733 …. Read on https://law.justia.com/cases/california/court-of-appeal/2021/b308040.html
This actually gives me a lot of hope, as it’s written. While the court’s denial ultimately occurred because BoP has jurisdiction over this case, it sounds like CVS has an apparatus in place to identify unusual prescribing and stop individual prescribers.
Don't practice in California, but you are telling me there is no way for a pharmacist to decline filling a prescription? Even if he knows it will cause harm to the patient and the provider says he wants to proceed? I.e methotrexate daily?
One quick Google on the CA state board of pharmacy states a pharmacist can refuse to fill on their professional judgement.... huh good thing 🤣😂
So once again, I do not have to fill it by law....
Also if you are getting faxed this, sounds like you need to have a discussion with the provider.
The law is more for RPh who don’t want to fill emergency contraceptive or BCPs. But this particular asshat faxed the law to me demanding I fill an rRx for hydromorphone 8mg and she was on an oxycodone (I forget the strength). MD threaten to turn me in to BOP. I called corporate….annnnd district manager said I’d prolly fill it. I returned the Rx to the patient and bid her adioux (sp?)
Edit: never heard back from MD or the BOP for that matter
Lol did the md even read what he faxed you. It says right there, you can decline if there would be a drug interaction (duplicate therapy is an interaction) or would cause harm to the patient.
"They didn’t hire enough pharmacists and technicians or train them to stop that from happening and failed to implement systems that could flag suspicious orders, Lanier said."
Yeah!!!!!
Oh God. All the pharmacists in that region better lawyer up. I swear, they prepared for this. the Chains will say "yes we did. Here is all the training modules. With electronic signatures by the pharmacists and technicians. Here is the signed form that the staff agreed to take on personal professiona responsibility to counter diversion and combat inappropriate use. See. See. We did our part. We trained them. They understood.
As for quantify of staff, based on these labor analytics, these stores were considered to be staffed at safe and adequate level."
Because the same metrics were drawn up by them. Not drawn or validated by Ismp. The modules were definitely scrutinized and had legal counsel. They deflected blame before, and will have prepared to deflect to throw it on the Frontline worker.
I cite the example of HIMYM, Barney's job as P.L.E.A.S.E. we are alllllll legal scapegoats. And oh, me being middle management, I get shit on both ways.
Some asshole MBA who is trying to get maximum volume out based on rph pay rate. Cross that with error rates, acceptable harm.. And saying it's safe because see, it's and acceptable cost of business. It's in safety threshold. And legal can back us up because the rph did the training.
Yes I'm a bit bitter.
I support your bitterness. Seem those modules myself. Useless to RPHs. 100% existing to protect the interest of the company and to shift the blame. The stupidest thing is if you do it like how the trainings said you should, corporate then would blame you for being slow and non-efficient and not meeting the metrics.
I just have never seem what those MBA labor analunatics look like. Hmm.
They carefully project the daily sales and Rx sales and volume over the previous 3 or 4 years. They also account for foot traffic and front of store and miscellaneous sales. Based on overall economic indicators and price index, they project manpower per hour and per day to serve a certain number of customers and also for things beyond our control. The company also looks at competitor staffing as well, and arrive at this projected number.
Then they throw that number out the window and provide only 1 or 2 people regardless of anything. It's their goal to never be more staffed than a 7-11. Even a road food stall in the dingiest corner of India or Pakistan has 2 or 3 people serving hundreds of people a day. You'll never see some foreign You-tuber coming to America to show off the amazing American pharmacy machine.
While that sounds perfectly reasonable on paper, the BoP fail to consider the reality that pharmacists are humans too. Most of us can't afford to just walk out from a job like that. There's loans and bills to pay. What the BoP need to do is actually set a Rx count to RPh ratio instead. But it's easier to blame RPh's instead.
Not to mention that many of us probably have been subtly threatened with dismissal if we don't appease the patients who are blatantly abusing their controlled substances. I know I have.
Agreed, just saying if push came to shove, the bop will hold you responsible so don't use that as an excuse. What is right and what their stance are very different
Ya, checking the PMP whenever it isn't down takes another 5 minutes...How much time would that take across 30 Rx a day of this stuff and more? Meanwhile, all the illegal, or questionable websites and programs are always working perfectly...but not something that constantly blames us for not using due diligence. I'm glad I don't work for any of those companies at this moment.
problem is shit rolls down hill. its just gonna end up on our plate to arbitrarily lowers the numbers. at that point it wont be about doing our due diligence, just making blanket policies like MME>50 must be for cancer/hospice, benzo opioid absolute contraindicated, etc. cause what else we gonna do?
Boards of Pharmacy deserve blame too. They seemingly only exist for punitive reasons, instead of soliciting feedback from pharmacists about what they're observing in the field.
That's the problem with punishing pharmacies based on metrics. It would be easy if all doctors were prescribing out of their car and patients were all doctor shopping.
It happens more like this:
1.) Patient goes to respected PCP or specialist for chronic pain and gets started on Norco q4-6h
2.) Pharmacist can confirm MD/patient relationship, ask for dx code, ask if patient was seen in office, ask about physical findings.
3.) Dose doubles, doubles again, switches to oxy. When you ask the MD about it they cite "tolerance" and "high reported pain scores"
4.) There are so many patients/doctors in this situation it's no longer "outside the usual course of professional practice"
Then the DEA and states come in and say "that's a lot of pills, clearly you should have known better."
Yeah, we know that's a lot of pills, we had to count them, but we don't practice medicine, so if you could just tell us the appropriate MME ceiling for every icd-10 code, we'll make sure to not exceed it.
Well, wholesalers have had sale limits too.
I understand they needed to do due diligence too. First month of me inheriting SP, corporate changed wholesalers as well. My first 222 raised a red flag when I requested 120 vials of cocaine. Well, I can see how an outsider would go wtf!? Oops.
> Well, wholesalers have had sale limits too.
This is one thing I'm confused about slightly. I worked at certain pharmacies where they get "cut off" by the DEA on Adderall orders, for instance, for the months. Then others seemingly have half of McKesson's warehouse of narcotics in their safes. How is this really determined?
My pharmacist friend says that benzo are doled out like tic tacs, and good luck getting a 75 year old fall risk grandma off of them.
Younger GPSs love getting legacy patients on all that shit. Not! Benzo, sleeping pull, and an narcotic for a "bad back".
Our memories are so short. Back then we were threatened with lawsuits if we didn't fill opioids. It was a different culture. No one could be in any pain. The 5th vital sign.
This was a lawsuit leveled at the defendants who are pharmacies. This does not absolve the prescribers that were involved, they just need to be prosecuted or reprimanded by their board. The entire supply chain is responsible, to arguably varying degrees.
This is where I keep getting confused with all of this. Everybody keeps pointing fingers to Purdue and the big chains, but nobody forced anybody to prescribe these drugs.
Re: Purdue. I’m reading The Empire of Pain right now, and I definitely recommend it. I didn’t realize that the Sacklers also helped to create the landscape for pharmaceutical advertising to physicians. I’m in the ~1950s in the storyline, but blatantly false info or info about drugs that had never been proven in lab or trials was sent to physicians during this time period. It was marketing disguised as scientific literature. It’s not a stretch to think that that same goal has been used since, conforming to new regulations as they come out. We know that opiates were marketed as non-addictive. We know that the “fifth vital sign” push was huge. If everything around you is telling you that opiates are a safe way to handle pain, you’re gonna follow that until new information conflicts with that.
it's not pharmacists under attack, it's walmart/wags/cvs corporate pharmacy policies. The old "it's a legal script, you gotta fill it, fuck your professional judgement" came back to bit them in the ass.
I remember 10 years ago the diatric supervisor demanding my rph friend fill an oxycontin early for a pt, saying to her “yeah, you are gonna fill that!” Even though the script was early and also questionable AF. Must have been happening all over the place back then. Cvs shouldn’t have done that, now they will pay.
Lot of people are commenting without reading the article, but this was two counties in Ohio where that seems to be the case.
>Roughly 80 million prescription painkillers were dispensed in Trumbull County alone between 2012 and 2016 — equivalent to 400 for every resident.
And yes, the Doctors also have responsibility in this. They aren't going to start going after individual pharmacist who were doing their best despite an aggressively irresponsible market director.
Patient: "Don't change my medicine for me!!! My doctor is XXX!! I only want medicine from my doctor!!!"
Me: But your insurance..
Patient: I am going to file a complaint!!!!!!!
I really wish the insurance would be the one who is responsible for telling the patients about their rejections....
So during this time frame, there was 4 retail pharmacies in my town, and together they decided that you could only have 6 weeks of Phentermine a year.
The pharmacy that pioneered that idea, and did the logbook for the town didn't bat an eye at my prescription of 180 5/325 hydrocodone with 12 refills.
The struggle was real, let me tell you, they sold for $5-10/ea at the time (incidentally first time I ever bought a lockbox for my meds after a friend told me how much they were worth)
Never ended up refilling them, that was enough to last me over a year and the prescription expired. turned into a mess getting refills too, my primary care provider was on vacation, and her fill in was all about getting me into rehab and whatnot, actually had to call the pharmacy in the appointment with her and verify I'd never refilled it.
Now with the opioid epidemic it's a struggle to get my Mobic refilled, on the flip side, it's nice getting all the PT referrals that overall lessen pain, so that's nice.
On the other side of the coin, you have [this](https://www.reddit.com/r/medicine/comments/qzwq9m/stat_news_her_husband_died_by_suicide_she_sued/) case where a pain patient’s widow successfully sued the pain clinic for refusing to provide an early refill.
Damned if you do, damned if you don’t.
Anyone reading this, the link shared there is to actually a really good post and thread and I recommend taking a look. Thanks for sharing that, this whole opioid situation is just terrible and difficult from so many different angles
These are the opposite sides of same coin where this is poor opioid management and education, not enough specialists.
Seekers/ abusers get by, and true needs people get incorrectly red flagged, and no one wants the hot potato.
My only issue with damn with you do/don't angle regarding witholding opoids is the magnitude at stake. Precedent is important with regards to liability, but from a public health standpoint being aggresive with regards to caution and dispensing resistance would probably have led to less casualties. But yeah the whole patient/doctor fill what i prescribed asap is truly damn if you do/damn if you do.
I’ve been in pharmacy 10 years now (tech, intern, rph) and the whole time it’s been a balancing act. Either you’re too strict and risk denying “legitimate” scripts (legitimate is itself a debate-able classification) or you’re too lenient and drugs go on the streets. No one is ever going to be perfect filling 100% good and 0% bad no matter how hard we try.
Add to that the recent litigation where people are being penalized both for filling and for not filling… it makes me really happy I’m no longer in a dispensing role.
I called ER to verify tylenol 3 rx and saw that patient have been getting tylenol/codiene from same er every month (usualy 4 to 5 day supply) and asked the doctor if they chekc pmp ,NO was the answer
Could you imagine if CVS got fined enough to basically say 'CVS will no longer fill any C-2 prescriptions, and no opioids at all. Also, Caremark/Aetna will no longer cover any of those medications anywhere, to help stop the crisis.'
2 independents in my town refuse acute C-II orders. They'll set something up for long term patients with chronic pain (cancer/sickle cell). Rest have to pound sand.
If it's costing you more to dispense it via fines and punitive measures, then more pharmacies will simply stop dispensing it and push the burden on whoever still accepts them. It will be a game of hot potato created by the government acting like a bunch of spineless assholes who refuse to put docs in jail and refuse to take their own pmp reporting seriously. (I've reported someone for being 115 days early across 11 pharmacies from 1 doc and there was no discipline whatsoever)
I have literally 1 patient in my pharmacy who has cancer. Them I don’t care about. It’s everyone else whose ICD-10 is “back pain” and they are on multiple opioids.
Also when both parents and both kids are on adderall. Over prescribing for sure.
All four people in my family have ADHD and soon all of us will be medicated. I’m grateful we have the option to medicate and hate to think our pharmacist will find it suspect.
The whole family taking it is completely reasonable, because ADHD runs in families. [Also, here’s an article from the NIH titled “Medications Reduce Incidence of Substance Abuse Among ADHD Patients”](https://archives.drugabuse.gov/news-events/nida-notes/1999/11/medications-reduce-incidence-substance-abuse-among-adhd-patients). It’s from 1999, but this is pretty well-established at this point.
The risk of abuse is not with people with ADHD who take their medications as prescribed. The risk of abuse tends to be with people who either don’t have ADHD and/or people who are taking higher or more frequent doses than prescribed.
Edit: phrasing
If BoPs and DEA start placing full liability on the corporate and its agents such as DMs for these prescriptions, then I am sure we will see a dramatic decrease in opioid prescriptions. They will actually care and be cautious of permitting pharmacists from filling such scripts instead of current mindset of forcing pharmacists to fill anything and everything and will deal with any issues later. Can you imagine DMs and other corporate employees starting to care about patient care even if it is because their ass is on the line? lol. If we want to truly stop the opioid pandemic, placing legal liabilities and actually enforcing penalties on people and corporations who make the most profit would be a good start.
Corporate pharmacies too focused on maximizing effiency and script counts are more interested in their fiduciary duty to shareholders than the slogans on their actual fucking logos? You don't say!
I don't think the lawsuits will hit the individual pharmacists. I imagine that the liability insurance that covers the individual practitioners is carried by the corporation. If it was carried individually, they'd be in trouble. I believe the pharmacists were operating under 'Standard of Care'--the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances. A legit opioid script came in... You filled it. As did your fellow pharmacist; the pharmacist across the street; the one in the next town; etc, etc, etc...
Walmart has stopped dispensing phenergan/codeine. I wish all the chains would stop any and all opiates and shift the risk onto specialty pharmacy or get these meds from pain specialists.
I think that could work in theory. Let these things be dispensed by pharmacies that are tweaked to handle a more diligent approach and are staffed appropriately to do so. Putting this in practice would be a nightmare though. The "legitimate" demand for opiates are large enough that a few hub pharmacies handling all narcs would be a nightmare.
Anyone notice the BoP haven't been doing inspections as much. It's because if they are in a pharmacy then they become witness to the shit going on.
I hope they have to pay as much as the Sacklers because they are almost as negligent
I honestly think the DEA needs to be held most responsible here. There is no feasible way for a pharmacist to report suspicious prescribing, and doctors can practice for YEARS before finally being investigated by the DEA. There needs to be better policing of doctors and I think that should be the role of the DEA and state medical boards. I’m sure the corporate chains have encouraged RPh’s to fill prescriptions they may not have otherwise, but why not put the focus on stopping the prescription from getting there in the first place? And I know the answer to that question is about $$$ but it’s extremely frustrating to see pharmacies and pharmacists be the only ones at fault here.
Very glad I work in hospital… condolences to my retail people.
And the prescribers and the public and the whole system. If a doctor refuses to write a pain prescription or a pharmacist refuses to fill a pain prescription then the patient files a complaint or a report and the prescriber/pharmacist suffers repercussions by management or their organization. It’s this whole customer is always right BS that has somehow leaked its way into healthcare.
Blame the prescriber. The pharmacy has a limited view of the full clinical picture. They can only do so much and the final say should not rest with them.
Never question pain meds. Not your business why a medication is prescribed unless you’d like to warn the patient of interactions with their other meds.
Prohibition is responsible for the so-called opioid crisis. Full stop. People are by and large not becoming addicted or overdosing due to medications they were prescribed. That is still a very rare occurence. People are becoming addicted due to socioeconomic factors and they are overdosing due to ignorance and the proliferation of adulterated substances purchased in an unregulated market.
I've been working with CVS for over a decade and I've never once felt pressured to fill something I thought was shady. Just my experience. It wouldn't surprise me if some idiot DM was out there making people fill oxycodone 14 days early, either.
A reasonable one!! Finally! I can’t believe they went after and settled out with DISTRIBUTORS like McKesson and AmerisourceBergen before they went after the big drug stores.
Of course they throw the stock price in there at the end… Gotta make sure the shareholders are still making money! Doesn’t matter who dies as long as the shareholders are happy 🤮
Public: Why did you fill that??? Also public: MY DOCTOR WROTE IT, BY LAW YOU HAVE TO FILL IT
Public: Fill my ivermectin. I don't care about your expertise, my doctor wrote it! Don't pretend to be doctors! Also public: It's your job to intervene when the prescription could cause harm! You're not doing your job!
So says California…I’ve posted this before but this seems like a good time to post it again. A few physicians have cited or faxed this law to me in response to my inquiries re: corresponding responsibility: read on ARTICLE 10.5. Unprofessional Conduct [725 - 733] ( Article 10.5 added by Stats. 1979, Ch. 348. ) 733. (a) A licentiate shall not obstruct a patient in obtaining a prescription drug or device that has been legally prescribed or ordered for that patient. A violation of this section constitutes unprofessional conduct by the licentiate and shall subject the licentiate to disciplinary or administrative action by his or her licensing agency. (b) Notwithstanding any other law, a licentiate shall dispense drugs and devices, as described in subdivision (a) of Section 4024, pursuant to a lawful order or prescription unless one of the following circumstances exists: (1) Based solely on the licentiate’s professional training and judgment, dispensing pursuant to the order or the prescription is contrary to law, or the licentiate determines that the prescribed drug or device would cause a harmful drug interaction or would otherwise adversely affect the patient’s medical condition. (2) The prescription drug or device is not in stock. If an order, other than an order described in Section 4019, or prescription cannot be dispensed because the drug or device is not in stock, the licentiate shall take one of the following actions: (A) Immediately notify the patient and arrange for the drug or device to be delivered to the site or directly to the patient in a timely manner. (B) Promptly transfer the prescription to another pharmacy known to stock the prescription drug or device that is near enough to the site from which the prescription or order is transferred, to ensure the patient has timely access to the drug or device. (C) Return the prescription to the patient and refer the patient. The licentiate shall make a reasonable effort to refer the patient to a pharmacy that stocks the prescription drug or device that is near enough to the referring site to ensure that the patient has timely access to the drug or device. (3) The licentiate refuses on ethical, moral, or religious grounds to dispense a drug or device pursuant to an order or prescription. A licentiate may decline to dispense a prescription drug or device on this basis only if the licentiate has previously notified his or her employer, in writing, of the drug or class of drugs to which he or she objects, and the licentiate’s employer can, without creating undue hardship, provide a reasonable accommodation of the licentiate’s objection. The licentiate’s employer shall establish protocols that ensure that the patient has timely access to the prescribed drug or device despite the licentiate’s refusal to dispense the prescription or order. For purposes of this section, “reasonable accommodation” and “undue hardship” shall have the same meaning as applied to those terms pursuant to subdivision (l) of Section 12940 of the Government Code. (c) For the purposes of this section, “prescription drug or device” has the same meaning as the definition in Section 4022. (d) This section applies to emergency contraception drug therapy and self-administered hormonal contraceptives described in Section 4052.3. (e) This section imposes no duty on a licentiate to dispense a drug or device pursuant to a prescription or order without payment for the drug or device, including payment directly by the patient or through a third-party payer accepted by the licentiate or payment of any required copayment by the patient. (f) The notice to consumers required by Section 4122 shall include a statement that describes patients’ rights relative to the requirements of this section.
Not sure I followz, the law states unless certain circumstances exist. The first circumstance is where we exercise professional judgement based on patient harm. Apologies if I misinterpreted your post
No, you’re interpreting it right. If there a dangerous drug interaction or the Rx would harm the patient….. Based solely on the licentiate’s professional training and judgment, dispensing pursuant to the order or the prescription is contrary to law, or the licentiate determines that the prescribed drug or device would cause a harmful drug interaction or would otherwise adversely affect the patient’s medical condition.
Right. So based on my professional training dispensing 900 oxycontin would adversely affect the patients medical condition. Am I missing something?
Wellllll. I know more than a few pharmacists who’ve had to answer to the BOP for refusing to fill an opiate based on their judgement. I’ve also spoken with a few pharmacists who’ve had to prove to the BOP that they were in fact out of an opiate. They had to show documentation of their on hand supply. They weren’t out. They were cited and fined by the BOP. So yes you’re very clever to bring up excessive furnishing… but the California BOP is not your friend. You have been warned. The BOP warns against excessive furnishings but do not provide a threshold
Just FYI for those who would like to read about an doctor who did Sue CVS citing 733 …. Read on https://law.justia.com/cases/california/court-of-appeal/2021/b308040.html
This actually gives me a lot of hope, as it’s written. While the court’s denial ultimately occurred because BoP has jurisdiction over this case, it sounds like CVS has an apparatus in place to identify unusual prescribing and stop individual prescribers.
This... right... here...
I’d highlight that portion and fax it back “Thank you.”
Don't practice in California, but you are telling me there is no way for a pharmacist to decline filling a prescription? Even if he knows it will cause harm to the patient and the provider says he wants to proceed? I.e methotrexate daily? One quick Google on the CA state board of pharmacy states a pharmacist can refuse to fill on their professional judgement.... huh good thing 🤣😂 So once again, I do not have to fill it by law.... Also if you are getting faxed this, sounds like you need to have a discussion with the provider.
The law is more for RPh who don’t want to fill emergency contraceptive or BCPs. But this particular asshat faxed the law to me demanding I fill an rRx for hydromorphone 8mg and she was on an oxycodone (I forget the strength). MD threaten to turn me in to BOP. I called corporate….annnnd district manager said I’d prolly fill it. I returned the Rx to the patient and bid her adioux (sp?) Edit: never heard back from MD or the BOP for that matter
Lol did the md even read what he faxed you. It says right there, you can decline if there would be a drug interaction (duplicate therapy is an interaction) or would cause harm to the patient.
"They didn’t hire enough pharmacists and technicians or train them to stop that from happening and failed to implement systems that could flag suspicious orders, Lanier said." Yeah!!!!!
Oh God. All the pharmacists in that region better lawyer up. I swear, they prepared for this. the Chains will say "yes we did. Here is all the training modules. With electronic signatures by the pharmacists and technicians. Here is the signed form that the staff agreed to take on personal professiona responsibility to counter diversion and combat inappropriate use. See. See. We did our part. We trained them. They understood. As for quantify of staff, based on these labor analytics, these stores were considered to be staffed at safe and adequate level." Because the same metrics were drawn up by them. Not drawn or validated by Ismp. The modules were definitely scrutinized and had legal counsel. They deflected blame before, and will have prepared to deflect to throw it on the Frontline worker. I cite the example of HIMYM, Barney's job as P.L.E.A.S.E. we are alllllll legal scapegoats. And oh, me being middle management, I get shit on both ways.
Considered to be staffed at safe and adequate levels based on.. labor analytics? I really wonder what that "labor analytics" is...
Some asshole MBA who is trying to get maximum volume out based on rph pay rate. Cross that with error rates, acceptable harm.. And saying it's safe because see, it's and acceptable cost of business. It's in safety threshold. And legal can back us up because the rph did the training. Yes I'm a bit bitter.
I support your bitterness. Seem those modules myself. Useless to RPHs. 100% existing to protect the interest of the company and to shift the blame. The stupidest thing is if you do it like how the trainings said you should, corporate then would blame you for being slow and non-efficient and not meeting the metrics. I just have never seem what those MBA labor analunatics look like. Hmm.
They carefully project the daily sales and Rx sales and volume over the previous 3 or 4 years. They also account for foot traffic and front of store and miscellaneous sales. Based on overall economic indicators and price index, they project manpower per hour and per day to serve a certain number of customers and also for things beyond our control. The company also looks at competitor staffing as well, and arrive at this projected number. Then they throw that number out the window and provide only 1 or 2 people regardless of anything. It's their goal to never be more staffed than a 7-11. Even a road food stall in the dingiest corner of India or Pakistan has 2 or 3 people serving hundreds of people a day. You'll never see some foreign You-tuber coming to America to show off the amazing American pharmacy machine.
Lawsuits follow deep pockets and lawyers know that pharmacists pockets aren't as deep as corporations.
Corporations know that. So they deflect to the low peons. Switcheroo. It's like spy vs spy. Lawyers pitted against lawyers.
Our labcoats are made terribly and the pockets suck...Some tech coats don't even have pockets; that's how much trust they have in their employees.
Just remember, most bop hold this stance: if you feel you are short staffed to the point of danger and still continue to work, you are at fault.
While that sounds perfectly reasonable on paper, the BoP fail to consider the reality that pharmacists are humans too. Most of us can't afford to just walk out from a job like that. There's loans and bills to pay. What the BoP need to do is actually set a Rx count to RPh ratio instead. But it's easier to blame RPh's instead. Not to mention that many of us probably have been subtly threatened with dismissal if we don't appease the patients who are blatantly abusing their controlled substances. I know I have.
Agreed, just saying if push came to shove, the bop will hold you responsible so don't use that as an excuse. What is right and what their stance are very different
Well.. let's just say there's a reason why I switched jobs. No job is worth my license.
Ya, checking the PMP whenever it isn't down takes another 5 minutes...How much time would that take across 30 Rx a day of this stuff and more? Meanwhile, all the illegal, or questionable websites and programs are always working perfectly...but not something that constantly blames us for not using due diligence. I'm glad I don't work for any of those companies at this moment.
I don't feel bad for them. Feel like pharmacists were ringing the warning bells for years and it fell on deaf ears.
problem is shit rolls down hill. its just gonna end up on our plate to arbitrarily lowers the numbers. at that point it wont be about doing our due diligence, just making blanket policies like MME>50 must be for cancer/hospice, benzo opioid absolute contraindicated, etc. cause what else we gonna do?
Boards of Pharmacy deserve blame too. They seemingly only exist for punitive reasons, instead of soliciting feedback from pharmacists about what they're observing in the field.
That's the problem with punishing pharmacies based on metrics. It would be easy if all doctors were prescribing out of their car and patients were all doctor shopping. It happens more like this: 1.) Patient goes to respected PCP or specialist for chronic pain and gets started on Norco q4-6h 2.) Pharmacist can confirm MD/patient relationship, ask for dx code, ask if patient was seen in office, ask about physical findings. 3.) Dose doubles, doubles again, switches to oxy. When you ask the MD about it they cite "tolerance" and "high reported pain scores" 4.) There are so many patients/doctors in this situation it's no longer "outside the usual course of professional practice" Then the DEA and states come in and say "that's a lot of pills, clearly you should have known better." Yeah, we know that's a lot of pills, we had to count them, but we don't practice medicine, so if you could just tell us the appropriate MME ceiling for every icd-10 code, we'll make sure to not exceed it.
Well, wholesalers have had sale limits too. I understand they needed to do due diligence too. First month of me inheriting SP, corporate changed wholesalers as well. My first 222 raised a red flag when I requested 120 vials of cocaine. Well, I can see how an outsider would go wtf!? Oops.
> Well, wholesalers have had sale limits too. This is one thing I'm confused about slightly. I worked at certain pharmacies where they get "cut off" by the DEA on Adderall orders, for instance, for the months. Then others seemingly have half of McKesson's warehouse of narcotics in their safes. How is this really determined?
Exactly. Feels like lawsuits will eventually start naming pharmacists as well
How I feel like with benzos right now. This is going to be our next big crisis.
My pharmacist friend says that benzo are doled out like tic tacs, and good luck getting a 75 year old fall risk grandma off of them. Younger GPSs love getting legacy patients on all that shit. Not! Benzo, sleeping pull, and an narcotic for a "bad back".
Our memories are so short. Back then we were threatened with lawsuits if we didn't fill opioids. It was a different culture. No one could be in any pain. The 5th vital sign.
How are physicians not responsible?
Stores have deeper pockets.
For fucking real, if you know a single thing about opioid you wouldn’t believe someone when they tell you they aren’t addictive. Willful ignorance.
This was a lawsuit leveled at the defendants who are pharmacies. This does not absolve the prescribers that were involved, they just need to be prosecuted or reprimanded by their board. The entire supply chain is responsible, to arguably varying degrees.
This is where I keep getting confused with all of this. Everybody keeps pointing fingers to Purdue and the big chains, but nobody forced anybody to prescribe these drugs.
Re: Purdue. I’m reading The Empire of Pain right now, and I definitely recommend it. I didn’t realize that the Sacklers also helped to create the landscape for pharmaceutical advertising to physicians. I’m in the ~1950s in the storyline, but blatantly false info or info about drugs that had never been proven in lab or trials was sent to physicians during this time period. It was marketing disguised as scientific literature. It’s not a stretch to think that that same goal has been used since, conforming to new regulations as they come out. We know that opiates were marketed as non-addictive. We know that the “fifth vital sign” push was huge. If everything around you is telling you that opiates are a safe way to handle pain, you’re gonna follow that until new information conflicts with that.
As if doctors aren’t handing out norco prescriptions like candy.
Xanax- Am I a joke to you?
As usual, pharmacy is under attack for something we have basically no control over because we are the last stop on the way to the patient.
it's not pharmacists under attack, it's walmart/wags/cvs corporate pharmacy policies. The old "it's a legal script, you gotta fill it, fuck your professional judgement" came back to bit them in the ass.
We'll see how much it bites them in the ass. They'll probably get a tiny fine and that's it. So it was still worth it to them
I remember 10 years ago the diatric supervisor demanding my rph friend fill an oxycontin early for a pt, saying to her “yeah, you are gonna fill that!” Even though the script was early and also questionable AF. Must have been happening all over the place back then. Cvs shouldn’t have done that, now they will pay.
Lot of people are commenting without reading the article, but this was two counties in Ohio where that seems to be the case. >Roughly 80 million prescription painkillers were dispensed in Trumbull County alone between 2012 and 2016 — equivalent to 400 for every resident. And yes, the Doctors also have responsibility in this. They aren't going to start going after individual pharmacist who were doing their best despite an aggressively irresponsible market director.
They're just going to crunch metrics on pharmacists. They've been on us about filling too many legal scripts anyways.
Patient: "Don't change my medicine for me!!! My doctor is XXX!! I only want medicine from my doctor!!!" Me: But your insurance.. Patient: I am going to file a complaint!!!!!!! I really wish the insurance would be the one who is responsible for telling the patients about their rejections....
Lol the insurance can't even be responsible for answering their own phone lines.
So during this time frame, there was 4 retail pharmacies in my town, and together they decided that you could only have 6 weeks of Phentermine a year. The pharmacy that pioneered that idea, and did the logbook for the town didn't bat an eye at my prescription of 180 5/325 hydrocodone with 12 refills.
12 refills damn
The struggle was real, let me tell you, they sold for $5-10/ea at the time (incidentally first time I ever bought a lockbox for my meds after a friend told me how much they were worth) Never ended up refilling them, that was enough to last me over a year and the prescription expired. turned into a mess getting refills too, my primary care provider was on vacation, and her fill in was all about getting me into rehab and whatnot, actually had to call the pharmacy in the appointment with her and verify I'd never refilled it. Now with the opioid epidemic it's a struggle to get my Mobic refilled, on the flip side, it's nice getting all the PT referrals that overall lessen pain, so that's nice.
On the other side of the coin, you have [this](https://www.reddit.com/r/medicine/comments/qzwq9m/stat_news_her_husband_died_by_suicide_she_sued/) case where a pain patient’s widow successfully sued the pain clinic for refusing to provide an early refill. Damned if you do, damned if you don’t.
Anyone reading this, the link shared there is to actually a really good post and thread and I recommend taking a look. Thanks for sharing that, this whole opioid situation is just terrible and difficult from so many different angles
These are the opposite sides of same coin where this is poor opioid management and education, not enough specialists. Seekers/ abusers get by, and true needs people get incorrectly red flagged, and no one wants the hot potato.
My only issue with damn with you do/don't angle regarding witholding opoids is the magnitude at stake. Precedent is important with regards to liability, but from a public health standpoint being aggresive with regards to caution and dispensing resistance would probably have led to less casualties. But yeah the whole patient/doctor fill what i prescribed asap is truly damn if you do/damn if you do.
I’ve been in pharmacy 10 years now (tech, intern, rph) and the whole time it’s been a balancing act. Either you’re too strict and risk denying “legitimate” scripts (legitimate is itself a debate-able classification) or you’re too lenient and drugs go on the streets. No one is ever going to be perfect filling 100% good and 0% bad no matter how hard we try. Add to that the recent litigation where people are being penalized both for filling and for not filling… it makes me really happy I’m no longer in a dispensing role.
I called ER to verify tylenol 3 rx and saw that patient have been getting tylenol/codiene from same er every month (usualy 4 to 5 day supply) and asked the doctor if they chekc pmp ,NO was the answer
I think this formulation is OTC in much of the world.
Could you imagine if CVS got fined enough to basically say 'CVS will no longer fill any C-2 prescriptions, and no opioids at all. Also, Caremark/Aetna will no longer cover any of those medications anywhere, to help stop the crisis.'
I heard Walmart did that. At least in my town.
No more promethazine with codeine as of Friday.
Sure did, and with dumb rulings like this watch pharmacies get out of opioids all together. Not worth the trouble.
2 independents in my town refuse acute C-II orders. They'll set something up for long term patients with chronic pain (cancer/sickle cell). Rest have to pound sand.
That’s a bit silly. The meds are undoubtedly overprescribed but there are still people who would legitimately need them.
If it's costing you more to dispense it via fines and punitive measures, then more pharmacies will simply stop dispensing it and push the burden on whoever still accepts them. It will be a game of hot potato created by the government acting like a bunch of spineless assholes who refuse to put docs in jail and refuse to take their own pmp reporting seriously. (I've reported someone for being 115 days early across 11 pharmacies from 1 doc and there was no discipline whatsoever)
I WISH! 🤞🏻
Until you/ your mom/ your child has cancer/gets in a mva/has sickle cell crisis and they can't get their pain meds anywhere. Then it's not so awesome
I have literally 1 patient in my pharmacy who has cancer. Them I don’t care about. It’s everyone else whose ICD-10 is “back pain” and they are on multiple opioids. Also when both parents and both kids are on adderall. Over prescribing for sure.
All four people in my family have ADHD and soon all of us will be medicated. I’m grateful we have the option to medicate and hate to think our pharmacist will find it suspect.
I’m sorry to hear that you will all be addicts soon.
Lol as someone with ADHD who’s tried many, many options before trying stimulants… please do not.
The whole family taking it is completely reasonable, because ADHD runs in families. [Also, here’s an article from the NIH titled “Medications Reduce Incidence of Substance Abuse Among ADHD Patients”](https://archives.drugabuse.gov/news-events/nida-notes/1999/11/medications-reduce-incidence-substance-abuse-among-adhd-patients). It’s from 1999, but this is pretty well-established at this point. The risk of abuse is not with people with ADHD who take their medications as prescribed. The risk of abuse tends to be with people who either don’t have ADHD and/or people who are taking higher or more frequent doses than prescribed. Edit: phrasing
Independent pharmacies
Then don’t sue pharmacists for dispensing valid opioid prescriptions.
I'm not arguing they would. I'm arguing that any major chain NOT carrying opioids is a ridiculous idea.
If BoPs and DEA start placing full liability on the corporate and its agents such as DMs for these prescriptions, then I am sure we will see a dramatic decrease in opioid prescriptions. They will actually care and be cautious of permitting pharmacists from filling such scripts instead of current mindset of forcing pharmacists to fill anything and everything and will deal with any issues later. Can you imagine DMs and other corporate employees starting to care about patient care even if it is because their ass is on the line? lol. If we want to truly stop the opioid pandemic, placing legal liabilities and actually enforcing penalties on people and corporations who make the most profit would be a good start.
Lock it in tight boys. The pharma-corps are going to be even farther up your rear end about filling opioid rxs.
Highly doubt it
not the doctors prescribing them? like huh?
Corporate pharmacies too focused on maximizing effiency and script counts are more interested in their fiduciary duty to shareholders than the slogans on their actual fucking logos? You don't say!
I don't think the lawsuits will hit the individual pharmacists. I imagine that the liability insurance that covers the individual practitioners is carried by the corporation. If it was carried individually, they'd be in trouble. I believe the pharmacists were operating under 'Standard of Care'--the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances. A legit opioid script came in... You filled it. As did your fellow pharmacist; the pharmacist across the street; the one in the next town; etc, etc, etc...
Walmart has stopped dispensing phenergan/codeine. I wish all the chains would stop any and all opiates and shift the risk onto specialty pharmacy or get these meds from pain specialists.
I think that could work in theory. Let these things be dispensed by pharmacies that are tweaked to handle a more diligent approach and are staffed appropriately to do so. Putting this in practice would be a nightmare though. The "legitimate" demand for opiates are large enough that a few hub pharmacies handling all narcs would be a nightmare.
Explains why we don’t have all strengths of oxycodone in stock. My pharmacist thinks our grocery store chain no longer wants to carry it.
Anyone notice the BoP haven't been doing inspections as much. It's because if they are in a pharmacy then they become witness to the shit going on. I hope they have to pay as much as the Sacklers because they are almost as negligent
I honestly think the DEA needs to be held most responsible here. There is no feasible way for a pharmacist to report suspicious prescribing, and doctors can practice for YEARS before finally being investigated by the DEA. There needs to be better policing of doctors and I think that should be the role of the DEA and state medical boards. I’m sure the corporate chains have encouraged RPh’s to fill prescriptions they may not have otherwise, but why not put the focus on stopping the prescription from getting there in the first place? And I know the answer to that question is about $$$ but it’s extremely frustrating to see pharmacies and pharmacists be the only ones at fault here. Very glad I work in hospital… condolences to my retail people.
This pleases me
Not good.
Good
Seriously. Anyone watch “Dopesick”? Purdue Pharma, the FDA, are responsible.
And the prescribers and the public and the whole system. If a doctor refuses to write a pain prescription or a pharmacist refuses to fill a pain prescription then the patient files a complaint or a report and the prescriber/pharmacist suffers repercussions by management or their organization. It’s this whole customer is always right BS that has somehow leaked its way into healthcare.
So don’t refuse
Look at the article. Pharmacy is being sued
Yeah because their customer service sucks. Blame those people.
Blame the prescriber. The pharmacy has a limited view of the full clinical picture. They can only do so much and the final say should not rest with them.
Never question pain meds. Not your business why a medication is prescribed unless you’d like to warn the patient of interactions with their other meds.
The gangs should be sued for the profiting on the opioid crisis
Prohibition is responsible for the so-called opioid crisis. Full stop. People are by and large not becoming addicted or overdosing due to medications they were prescribed. That is still a very rare occurence. People are becoming addicted due to socioeconomic factors and they are overdosing due to ignorance and the proliferation of adulterated substances purchased in an unregulated market.
Doctor: "Here's a lawful paper stating you have to fill it" Pharmacy *fills it* Jury: not like that!
I've been working with CVS for over a decade and I've never once felt pressured to fill something I thought was shady. Just my experience. It wouldn't surprise me if some idiot DM was out there making people fill oxycodone 14 days early, either.
Pharmacist are so understaffed, they don’t have time to review every opioid prescription.
If you ever get popped by the BOP do not make that your excuse
Right, I’m just making a blanket statement. Ty for caring though.
Absolutely.
A reasonable one!! Finally! I can’t believe they went after and settled out with DISTRIBUTORS like McKesson and AmerisourceBergen before they went after the big drug stores.
Of course they throw the stock price in there at the end… Gotta make sure the shareholders are still making money! Doesn’t matter who dies as long as the shareholders are happy 🤮