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Pharmacy checklist questioning doctor prescriptions

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Pharmacy checklist questioning doctor prescriptions

By Kean Bauman. CREATED Apr 25, 2014

Las Vegas, NV (KTNV) -- It's a problem Contact 13 has been investigating for months. And the big question has been why are legitimate patients delayed or denied by area pharmacies?

Chief Investigator Darcy Spears found some answers in an internal document she obtained. Industry insiders say it shows how one major chain's policies are downright damaging.

You see them on busy corners all over town, "At the corner of happy and healthy" they claim. But patients and doctors say your friendly neighborhood Walgreens pharmacy isn't living up to those claims.

"Walgreens is almost universally the problem we have."

Dr. Jim Marx is a pain management specialist who's board-certified in addiction medicine. He works with patients like Sean Ladner.

"Totally paralyzed. Couldn't move at all," says Sean.

A 1991 car crash plus complications from a surgery four years ago left Sean in chronic pain. But he says getting his Oxycontin prescription refilled is becoming the real pain.

"It's been a real challenge the last 4 months with pain medication and pharmacies and just the way I'm treated. Walgreens is definitely the most difficult pharmacy that I've experienced."

Why is that?

"There are some items on here in that red flag list."

Robert Twillman is Deputy Executive Director of the American Academy of Pain Management. He sent Contact 13 this internal Walgreens document titled the Good Faith Dispensing Checklist.

Walgreens pharmacists are told to question whether the patient has received the prescription from Walgreens before. Is it the same medication from the same doctor? How long have they been on it? It even suggests a list of questions to ask prescribing doctors.

"We spend almost as much time on the phone with pharmacists as we do with patients," said Dr. Marx.

Dr. Marx got his first look at the Walgreens checklist when we brought it to his office, "This is disheartening."

It shows that pharmacists are told to verify diagnosis, question the standard of care and expected length of treatment.

In Sean's case?

"Traumatic quadriplegic. He's going to require treatment like this for the rest of his life," Dr. Marx explained.

Pharmacists are even told to question when the doctor last saw the patient.

"'What alternative or lesser prescription medications have been tried?' This is part of the process we go through in practicing medicine," said Dr. Marx. "And a pharmacist isn't really qualified to determine what that process is."

We also showed the Walgreens checklist to Dr. Dale Carrison, Chief of Staff at UMC.

"What are they going to validate? I mean, do I have to send an x-ray to the pharmacy with a patient to show that they have a problem?"

He said doctors, not pharmacists, know best, “"I prescribe the medications because they're medically necessary."

Twillman doesn't think pharmacies deserve all the blame.

"I really feel like the pharmacies in this are more victims than they are perpetrators because the pressure is on them from DEA."

Pressure, he said, to keep powerful drugs from being abused. But he says regulators are not providing enough guidance to pharmacies on how to do that.

"I think ultimately what we have to do is we have to change the way the D.E.A. is acting here and the only way that's going to happen is if pressure comes from congress."

The DEA provided Contact 13 this response:

"DEA communicates with all its registrants, including pharmacies, to help them understand the requirements of the Controlled Substances Act (CSA) and its implementing regulations when it comes to preventing the diversion of controlled substance prescription drugs (CSPDs). DEA holds day-long regional Pharmacy Diversion Awareness Conferences on weekends throughout the year, including 14 conferences in 2013, for pharmacists to attend to be briefed and ask questions. [We have not yet had one in Nevada, but last year we had 2 in California and 1 in New Mexico, and this summer we are holding conferences in Phoenix and SLC. I haven’t seen the schedule for the whole year.] DEA sets no quotas or limits on what pharmacies can dispense or what their distributors can provide them, but the CSA requires both pharmacies and distributors to know and communicate with their customers (in the pharmacies’ case, both patients and doctors) to help prevent diversion. DEA sometimes has to take administrative action when this process breaks down."

Sean Ladner just wants to know why pharmacies sometimes turn him away.

"At least if they were straightforward with me and say 'this is the reason' and I could go and go to a different pharmacy, it would be ok."

When we contacted Walgreens, they referred us to a previous statement:

"With the sharp rise in the abuse of prescription painkillers in recent years, health care professionals in all practices are continuously striving to find better ways of ensuring those medications are used only for legitimate medical purposes. We are working to ensure our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances. We have over recent months taken a number of steps to provide additional guidance and training to our pharmacies on the proper handling of controlled substances. Because of the legal requirements placed on pharmacists to verify that controlled substance prescriptions are issued for a legitimate medical purpose, pharmacists may need to gather additional patient information from their prescribing physician's office. This diligence may take extra time.

For example, under our good faith dispensing policy, pharmacists may determine that they first need to check the state's Prescription Drug Monitoring Program database for anything unusual. They may also decide to contact the prescribing doctor's office to verify the diagnosis and confirm that the patient has had a recent examination. Often, this information can be obtained from a member of the doctor's staff.

We firmly believe that addressing prescription drug abuse will require all parties - including leaders in the community, physicians, pharmacies, distributors and regulators - to play a role in finding practical solutions to combating abuse while balancing patient access to critical medication."

"We continuously review our procedures to ensure our patients have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances."

Contact 13 is once again reaching out to lawmakers to what they are doing to address this intricate problem.

If you are experiencing a problem with your prescription we want to know about it. Send us an email to 13investigates@ktnv.com.