Ask the Pharmacist: Why Am I Being Denied a Pain Medication?

Ask the Pharmacist: Why Am I Being Denied a Pain Medication?

Steve Ariens

Steve Ariens

(Editor’s Note: National Pain Report is pleased to welcome Steve Ariens as our newest columnist. Steve is a retired pharmacist and patient advocate who has a blog called Pharmacist Steve. His wife is a chronic pain patient.

If you have a question for Steve about your experience at a pharmacy, send it to AskthePharmacist@nationalpainreport.com.)

“My pharmacy refused to fill a prescription for pain medication. I’ve been going to them for years without any problems. What can I do?”

The pharmacy that you have known and had a good relationship with for years may have had a dramatic change in attitude and their ability to promptly meet your medication needs.

To understand the problem that you are having today, you need to go back to Florida in 2011, where the genesis was the Drug Enforcement Administration’s crackdown on two CVS pharmacies and the drug wholesaler (Cardinal) where they purchased their medications.

Florida, at the time, had a “pill mill” problem. The DEA claimed that these two stores sold TWENTY TIMES the doses of oxycodone than the average pharmacy does.

The DEA claimed that Cardinal knew or should have known that all of these opiate doses were for fake prescriptions or that the prescriptions were not for legitimate medical purposes.. Keep in mind that Cardinal never saw the first prescription or patient getting them filled.

Cardinal’s ability to sell controlled medications was suspended at its central Florida distribution center. Total cost to Cardinal in fines and legal fees was $34 million.

Since that time, Walgreens and CVS have also been fined by the DEA hundreds of millions of dollars for unaccountable missing doses of opiates. Just this month CVS was fined $29 million after an audit of four stores in Northern California.

Last week the DEA announced that they are also auditing four Costco pharmacies in Northern California. One Costco pharmacy in the Sacramento area was found to be purchasing more hydrocodone than any other pharmacy in California.

Understandably, all of these entities have tightened their procedures. The three major wholesalers — which control 90% of the business — have begun rationing the amount of opiates that a pharmacy can purchase in a calendar month.

American pharmacist with senior woman in pharmacyThey claim that it is at the insistence of the DEA, although DEA spokesman Rusty Payne told National Pain Report his agency was not the cause of the rationing.

In early 2013, Walgreens implemented their “Good Faith Dispensing Checklist” policy. It mandates that their staff pharmacists ask every patient about 10 questions for every new prescription for a controlled substance before filling it.

It doesn’t seem to matter if the patient had been getting their prescription filled at a particular store for years. If the patient and the prescription don’t meet all the “good faith” criteria, the Walgreens pharmacist cannot — by company policy — fill the prescription.

One of the more controversial parts of this policy is that no new prescriptions for controlled drugs could be filled within 72 hours of being received. If prescribers don’t provide the patient with a 3 day “grace period” when issuing the new prescription, that patient is going to be thrown into elevated pain and withdrawal.

Withdrawal puts the patient at risk for a hypertensive crisis (very high blood pressure), possibly resulting in stoke and/or death.

Some believe that this delay or denial of a chronic pain patient’s legitimate prescription is a violation of their civil rights under the Americans with Disability Act (ADA).

The ADA parallels the Civil Rights Act of 1964, except it applies only to those that are disabled.

Some also believe that the denial of a chronic pain patient’s prescriptions could result in unprofessional conduct charges against the pharmacist involved with the appropriate state Board of Pharmacy.

Other entities that could be behind the refusal of a prescription being filled are: drug wholesalers, the permit holder (chain/store owner), PIC (Pharmacist in charge), or staff pharmacist. All are licensed by the appropriate state Board of Pharmacy

I have created a a one page set of instructions, with links to the appropriate websites, on how to file an ADA, Health Insurance Portability and Accountability Act (HIPAA), or Board of Pharmacy complaint. You don’t need an attorney, just fill out the online form on the appropriate website.

Make a paper/digital copy and take it to your pain doc, they are probably as unhappy as you are that your prescriptions are being denied. Suggest that they give the instructions any other patients that are having problems.

If you have a question for Steve, send it to AskthePharmacist@nationalpainreport.com.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

There are 17 comments for this article
  1. Noel at 9:24 am

    I have a question. I am very aware of the Walgreen’s good faith checklist and have seen it. I have not seen the part that states your prescription can’t be filled for 72 hours. I have never had to wait 72 hours. Sometimes it takes 2 hours…..but never 3 days! So I was curious where you got that info from. Thanks

  2. Junior's Ghost at 10:45 pm

    I have a condition where my Achilles tendons in both feet are calcifying at the heels. I work on my feet all day. The pain can no longer be controlled by OTC meds and nobody will prescribe me anything stronger than Relafen. The surgery would be covered by my workplace. But since AFLAC views this as a preexisting condition, surgery would mean four or six or even eight months of not paying the mortgage the car payments, food, and on and on and on.

    I’m not an addict, I took Vicodin after a car accident in 1999 and neck fusion surgery in 2005 with no ill affects. I just want to be treated with dignity. NO ONE SHOULD HAVE TO SUFFER SEVERE PAIN NEEDLESSLY.

    If you haven’t already signed, I encourage everyone of you suffering due to the under treatment of your pain to sign the petition to congress. The link: http://www.petition2congress.com/5202/first-do-no-harm-dea-targets-physicians-who-treat-their-patients/ or you can Google: petition2congress First Do No Harm Whether you are suffering or love someone who is, this really needs not be a silent battle anymore. We are good hard working people who just want to work and not collect a disability check. Thank you.

    It doesn’t surprise me when I hear people are fleeing the U.S. because of medical issues. This for-profit, free-market health care system is destroying the lives of millions of Americans. Medical emigration from this country is becoming a more popular option by the day. It’s sickening both literally and figuratively. It’s corporatist greed, plain and simple. And because it’s corporatist it can also literally be called fascism. Welcome to Fascist America. Now go on and suffer like a good little patriot.

  3. Christina at 9:57 am

    The crazy thing is DEA is only creating more drug problems by scaring everyone. Druggies will just continue to find illicit drugs and sell them instead of pain meds and only resulting in legit pain patients suffering. I realize that drugs are abused but c’mon I would say the majority of people on meds need them. Get out on the streets and crack down and get out of the doctors, pharmacists, and suppliers business. If someone goes in and lies to a doctor about their pain eventually the doctor will call their bluff and if they are at pain clinics then eventually they will be busted via drug test or pill count. Just leave scripts alone and go find something else to control. I pray that these legit pain patients don’t turn to street drugs because that’s their only relief. Not only are you scaring pharmacies from filling and doctors from prescribing they are creating a new mindset in many of these health professionals that these patients are all druggies and it is just wrong. People should not be made to feel like that because they suffer from something they never asked for.
    The government cannot make enough money on the streets so they are busting good and honest medical professionals. All this is just wrong and so disgusting. Karma will be a bitch and pray that they will truly have to understand what it means to be in severe pain daily and then driving and calling to hundreds of pharmacies not to mention risk getting kicked out of pain management because they are getting to many calls verifying or questioning the patients scripts and the doctors don’t want to deal with it. Not only that they risk getting kicked out for using other or multiple pharmacies because no one has the medication in stock. Another topic, typically pain patients cannot pick up their scripts until the day they are due, so if they have to have extra time at the pharmacy than you have just thrown that patient into withdraws and then he or she will tell their doctors anything to try and get their scripts a couple of days earlier not to take them but hell just so they don’t have to go through agonizing withdraws on top of their normal pain. Again, risking them to again be kicked of a program that helps them. All of it is wrong and they should be thrown in jail themselves but ofcourse that will never happen so the only thing I can say is “karma will kick you in the butt”
    Praying for all who have to battle this saga. It is exhausting!

  4. Brenda Smith at 4:47 am

    I went to 5 pharmacists in one day who refused to honor my prescription for 14 kadian capsules. Finally had to get driver for hour trip back to Dr, pay for another apt to tell him. He called Walgreen and yes THEY had it. Drive there and they don’t. Told them funny they had it when Dr called. Oh, you are the one. Filled it for 58$ over what blue cross paid. Have not been arrested and my Dx was on script. Thanks for your help. Horrible being almost bedfast but with medication I can move some. I feel discrimination and embarrassment being treated like a criminal.

  5. EastSideHunky at 4:25 am

    Until pharmacists have a universal conscience clause, that covers all practice settings and possibilities, all these efforts go ahead in vain. Pharmacists will not properly execute their professional judgment in ANY aspect of pharmacy, not just pain control, if it hangs over their head like the Sword of Damacles.

    Pharmacists need to make professional judgments based on their training, moral, religious and ethical beliefs, regardless what the corporate front office wants. Otherwise, you may as well train chimps to fill any order that comes in front of them, without questioning anything.

  6. Eve at 1:42 pm

    Laura – my mother is on pain medications, but she cannot get her pain meds by mail order, and she cannot get more than 30 days at a time. She also must show up at the doctors office to pick up the prescription, it can’t be called in to the pharmacy – there are no refills on narcotic prescriptions. It is this way by law, not just for my mother.

  7. Suffering patient at 10:10 am

    I will not surprised if legitimate pain patients all end up at methadone clinics for pain relief in the near future. This has gotten so far out of hand and now is controlling everyone’s life who requires pain medications for legitimate pain reasons. Why is that addicts can go dose everyday up to hundreds mgs of methadone and be taken care of and the legal patient with pain having to suffer withdraws and increased anxiety every month? This is the future if nothing better happens. Mail ordering isn’t always on time. I have been left waiting a week for medicine. Send it too early? They mail the Rx back saying too soon to fill. Send it in time for 10 day turn around? It can be still be days after your 30 day’s supply is up. What about Americans that want to take vacations or have homes in two locations? We have NO rights anymore! We have no kind of normal lives anymore. I am just sick and tired of it all. Something needs give. Congress needs to get on the ass of the DEA and STOP this harsh overreacting. When is something going to change for innocent people?

  8. Pharmacist steve at 7:48 am

    @Laura.. I would like to see something printed where the DEA is pushing people to use mail order.. This is the first time that I have heard of this. If you have this.. I would like to get a copy.I know that the FTC is – for some reason – infatuated with mail order .. and openly promotes it. You have point out the security issues of getting your drugs getting lost in the mail.. The manufacturer, wholesaler,pharmacy are required by law to maintain proper storage temp of all meds most in the 59 -75 range.. but when a mail order outfit drops them into the hands of a delivery carrier.. the rules no longer apply. Ever see a air conditioned delivery truck ? Fentanyl patches are extremely sensitive to elevated temp above 75… they start releasing the drug from the patch.
    Of course if your Rx going to them or coming back gets mis-directed.. you have to start all over from scratch.. getting a new Rx from doc.. proving to the doc that it was lost in the mail.. and the process with the mail order firm.
    These mail order firms fill tens, if not hundred, of thousands of Rxs PER DAY.. your Rx is just another “bottle” going thru the system.. just like any bottle on an assembly line. I have heard of horror stores of what mail order companies call “customer service”.. like everything else .. your phone call is just another phone call.. do whatever you can to get the caller off the line as quickly as possible. When you call up to ask a question about your meds.. are you really talking to a Pharmacist.. or just technician that sounds like he/she knows what they are talking about.. A good sounding answer and the correct answer are not necessarily the same..

  9. Laura Lewis at 4:49 pm

    I have been through all of the above and my ultimate answer, after much research, is to go with Mail Order Pharmacy. Based upon what I read online (had to dig for this) and a survey that the DEA sent out to Medicare Retirees on prescription meds as their survey group, I discovered that the DEA is indeed pushing for Mail Order pharmacies despite the fact that the result of their survey was an overwhelming preference for patients to be able to obtain their meds at their local pharmacies. It is as if the DEA is looking to pretty much put local walk-in pharmacies out of the drug business; they will still be there for other sundry items but not for narcotics, per se. This would give the DEA a way to better control the medications being dispensed, I imagine. While I’m on Medicare Disability, not a senior citizen quite yet, I agree it would be best to be able to fill my prescriptions at my local pharmacy with a pharmacist who is available for questions or consult if needed and would be most convenient. With mail order, you must be able to go for up to ten days after you receive prescription from Doctor before you receive them in the mail. Also, security issues are a potential problem; once the meds have left the pharmacy, they are in the hands of the postal or overnight mail personnel. There is a risk involved for theft or mis-delivery of these very sensitive medicines—extremely dangerous in the wrong hands. Regardless of these issues, I have been able to rely on the fact that my medicine has been in my hands on time and eliminate the need to run all over town and beyond in attempt to obtain my much needed medications. Besides, people who are disabled like me are simply not capable of running (driving) all over for our medicines, especially after already being at the doctor for a few hours that day. We Are Disabled, after all. So, because I had been forced into withdrawals no less than three times here in Florida last year because the pharmacies would not fill my scripts, this is my decision now. BTW, I have been a pain patient for 22 years, was a Walgreen’s customer for 18 of those years and they won’t fill my scripts nor will CVS or anyone else. I could not possibly be more legit, and they certainly have all of my extensive records in their data bases. Never heard of the Walgreens 10-Question BS and the local store has some staff behind the counter that look like straight-up junkies. Walgreens did in fact short me on my opiates some years back; staff was fired after my complaint to headquarters. So—-tired of being insulted and treated like a crack-head by these offensive Pharmacy Techs and their bosses, my choice is Mail Order, the way of the future most likely. Hope this doesn’t jinx me and all will continue to go smoothly for me. They are definitely discriminating against good people who are very ill and disabled all the way around and it is an insult to anyone who already has to work five times harder than the average person just to get out of bed everyday and attempt to have a joyous and balanced and productive life.

  10. Pharmacist steve at 1:13 pm

    @Christina.. I am not aware of any law that limits what any retailer can charge for a product.. except when Florida is in a “emergency status” – before/after a Hurricane. I don’t have access to wholesale prices anymore.. but have read where the price of some generics have jumped 1000% or more.. with no reason.. I have also read where The Prescription Benefit Managers ( PBM) who does all the “drug card” processing. Most people don’t know this.. but the PBM’s establish the price that the Pharmacy gets paid for a particular prescription. I have also read about Pharmacists complaining about the PBM’s dragging their feet in reimbursing the pharmacy based on the current wholesale prices.. I have seen some stating that if they filled a Rx they would lose $100+. They are just turning down filling these Rxs. Normally, these PBM contracts have a clause that a pharmacy cannot charge a pt more than what is allowed by the PBM.. so if this particular pharmacy will bill your insurance company for your non-controls but only “cash” for the controls .. the pharmacy may be violating their contract with the PBM.. Filing a complaint with the fraud/abuse section of the PBM.. the pharmacy will either get their contract cancelled or they will come in and do a audit and fine the crap out of them.
    If I was you.. I would have a confidential conversation with the Pharmacist and tell him that you believe that he/she is in violation of their contract with the PBM that handles your Rx claims.. And ask them if they want to honor their contract.. fill your control drugs and bill the PBM .. like they do the rest of your meds…or you would be happy to contact the PBM’s fraud/abuse section and suggest that they audit the pharmacy.
    I believe that the average Pharmacist would not know the difference between a good MRI and a bad MRI. What blood tests are they requesting.. I see no valid reason for them to ask for them.. and could fall under discrimination under ADA.. unless they ask for A1c from diabetics and ask for labs on people on diuretics to see if their Potassium levels are good.. and the list could go on and on..

  11. E11 years at 9:44 am

    Thank you Steve for sharing this information and giving precise detailed avenues so pain patients can actually advocate for themselves. Thanks again!

  12. Christina at 12:28 am

    Thank you Steve for the information! Is there not laws against pharmacy not excepting insurance for narcotics and charging in the seven to ten dollars a tablet? This is a huge problem we are still having in Florida. Pharmacies asking for copies of our MRIs and blood work is this legal?

  13. Pharmacist steve at 7:20 pm

    @Dennis.. my recommendation is to get something signed by your Pharmacist that their wholesaler – get the name of the wholesaler – is rationing or shorting their orders. IMO.. the wholesaler is the genesis of a ADA discrimination/civil rights violation.. file the complaint against the wholesaler.. Likewise, the wholesaler is licensed by the state Board of Pharmacy (BOP).. I am not sure if you file unprofessional conduct and/or patient abuse against a wholesaler with the BOP.. But if you can get their BOP/wholesaler license at risk in a state.. it will get their attention.
    Here is something that I have put together.. to get the politicians’ attention on a larger scale http://www.pharmaciststeve.com/?p=5403

  14. Dennis Kinch at 1:35 pm

    What would you recommend as a solution to the rationing problem? That seems to be the biggest problem I face each month. The pharmacist says that each opioid script is “first come, first serve,” and there’s only so much to go around, then I wait until the next order date, usually 3 days later. There’s also a rule that these scripts have to be picked up at the doctor’s office and brought by hand to the pharmacy each month. If the doctor takes too much time writing the script I usually get there too late and miss my turn in line.
    I also have a pain script that has to be ordered each month by me, then the doctor can fax it to the pharmacy.

    I don’t know how any of these things helps with the DEA’s mandate of controlling the misuse of drugs. All it does is hurt legitimate patients. Why isn’t that enough? The fact we are a legal user under a doctor’s care should be enough. We are thoroughly checked out at the doc’s office.

    Every month around the 6th, I live in fear of how many days this month will I have to go without my meds for 3 days. Only twice last year did I have a smooth month. I feel like my health is in more jeopardy from this than from my disease!

  15. stevetoo at 11:16 am

    Am an aids patient who will probably be forced to find relief outside the medical community due to access problems related to drs and their lack of common sense. My psychiatrist told me he has narcoleptics unable to fill amphetamines. This is a bigger tragedy than most know. Who wants to “fight”an illness in horrible pain?

  16. carol levy at 10:28 am

    Thank you. We have just been dealing with a thread about being refused meds on our women in pain awareness support group. I will be sharing this article with them.