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Pharmacies creating barriers for patients filling controlled substance prescriptions
e-Reports, April 29, 2013
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Indiana physicians have reported to the ISMA that they are experiencing problems with getting their patients’ controlled substance prescriptions filled at pharmacies here. Specifically, the pharmacies are requiring patient information such as diagnosis codes, treatment history, treatment duration, payment method and treatment plans – before they will fill the prescription order.

The information is not required by state or federal law in order for prescriptions to be valid. However, the U.S. Drug Enforcement Administration’s (DEA) investigation and discipline of major pharmacies in Florida has prompted the agency to change its practices nationally, including here in Indiana.

More about the law
Federal law requires that prescriptions for controlled substances be issued for legitimate medical purposes by individual practitioners acting in the usual course of their professional practice. That same law imposes responsibility on pharmacists who fill the prescriptions. If pharmacists knowingly fill improper prescriptions, they, as well as the prescribers, can be punished.

Similarly, state law requires pharmacists performing their duties to exercise professional judgment in the best interest of patients’ health. Before honoring prescriptions, they are required to take reasonable steps to determine whether a prescription has been issued in compliance with state law.

A pharmacist can refuse to fill a prescription if professional judgment suggests filling it would be contrary to law, be against the best interest of the patient, aid or abet an addiction or habit, or be contrary to the health and safety of the patient.

What’s now occurring
The pharmacies report that DEA agents are regularly visiting their stores and asking to inspect prescriptions. As expected, the agents seem to be focused on opioids and poly-substance prescribing, as well as large doses and long-term supplies of drugs. Additionally, they are looking for red flags about the patient from sources like INSPECT data, the physician’s prescribing patterns and the medical office (e.g., suspicious business practices).

The ISMA contacted Walgreens to express concern about the drug store chain’s lack of communication to the prescriber community in our state. The ISMA has learned from members that other pharmacies – including CVS – may be taking similar action.

Therefore, the ISMA notified the Board of Pharmacy, which added the issue to its agenda and asked the pharmacies to attend its next meeting. At that session, the ISMA presented physicians’ concerns about the overreaching policies that had not been communicated, and board members echoed that concern.

Walgreens has now prepared a letter for pharmacists to deliver to their prescribers. The letter states that pharmacists “are required to take additional steps when verifying certain prescriptions for controlled substances” and that the “verification process may, at times, require the pharmacist to contact you for additional information necessary to fill the prescription.”

The letter also says, “while the information requested may vary, potential questions could include information about the diagnosis, ICD-9 code, expected length of therapy and previous medications/therapies tried and failed.”

Federal privacy laws, such as HIPAA, do permit doctors to share patient information for treatment purposes with other health care professionals, including pharmacists. Walgreens acknowledges that this verification process may require additional time from you or your office staff. But they believe this action is necessary to fulfill their role in reducing the potential abuse of controlled substances.

The ISMA intends to meet with the DEA next.

As various news outlets have reported, the Office of the Indiana Attorney General has filed complaints with the Medical Licensing Board of Indiana against several Indiana physicians for improper prescribing practices, as a result of information received from the DEA and pharmacies. Those physicians face potential financial penalties and discipline regarding their medical licenses.

What can you do?
All physicians are encouraged to attend ISMA’s May 10 Continuing Medical Education seminar, “Responsible Pain Management Prescribing: Strategies for everyday practice.” The session will bring you up to date on the latest pain management practices so you can avoid scrutiny from state and federal agencies. You’ll learn to use patient contracts and other tools, and hear about alternative therapies for managing chronic pain.

Reserve Friday afternoon May 10 on your calendar now and find more details here.

pain management
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