Ask the Pharmacist: Can a Pharmacy Delay Filling a Prescription?

Ask the Pharmacist: Can a Pharmacy Delay Filling a Prescription?

Dear Steve,

I suffer from chronic lower back pain.  My pain resulted from a combination of bad genetics (spondylolisthesis) that was exacerbated by a head-on collision in 2009.  I take hydrocodone (Norco) four times a day. 

As an environmental consultant, my job requires that I travel — often for several days at a time and even on weekends.  

cvs-pharmacy-logoBecause of my travel schedule, I can often be out of town on the date that I am up for a new prescription. I changed to a nationwide pharmacy (CVS) to minimize this risk. In the past, I could get a prescription for hydrocodone filled 2 or 3 days in advance, which greatly helped me in making sure I could stay on track and manage my pain while traveling. 

But today, I ran into a problem.  I have a prescription that was written by my doctor to be dispensed today (12/2/2014).  However, I did not fill my last prescription (written for dispense on November 4th) until November 6th because I was traveling and could not fill it sooner. 

Now, CVS is telling me that I cannot fill the new one as it is too early to fill right now.  

My question is if the actual prescription date for dispense is today (12/2), is it legal for them to deny filling it until 12/4?  Without the medication, I will be in a world of hurt and will certainly have trouble performing my job.  

Andy in Alabama  

Dear Andy,

It seems like I get an email like yours several times a week. In my opinion, way too many pharmacists when it comes to filling controlled medications have become bean counters.

They look at today’s date minus last day filled and if it doesn’t compute to 28-30 days, they are going to say no even if the doctor says it is okay. It is as if someone is going to do some harm to themselves if it is filled a couple of days early — unlike when they get a full month’s supply on hand and decide to do something harmful to themselves.

Most of these pharmacists have a great deal of “book smarts” but little or no clinical experience with subjective diseases (pain, mental health, anxiety, depression, ADD/ADHD). All they know is what they have read in a book or they were taught by someone at college in an “ivory tower” who has more book smarts than clinical experience.

They seem to have forgotten that all of us are individuals and our bodies respond as such, and that there are no black and white answers to individual medical care — especially subjective diseases.

If I was in your place, I would have my attorney send CVS’s legal department a letter stating that if their pharmacists continue to not follow doctor’s orders and cause you to lose business, force you to take days off, or even lose your job because you are not able to get your meds on a timely basis — causing incapacitating pain, withdrawal, hypertensive crisis, stroke, death, etc. — that you will hold both the pharmacist and the corporation responsible.

I would also include in the letter that you are going to file complaints with the Alabama Medical Licensing Board and Board of Pharmacy that the pharmacist is practicing medicine without a license, as well as file a civil rights violation/discrimination complaint under the Americans with Disability Act, for not following best practices and standard of care.

Too bad you can’t file a complaint for the pharmacist being a general PUTZ !

I would also file complaints with your insurance company and/or your human resource office for denial of care and patient abuse.

Steve AriensSteve Ariens is a retired pharmacist and patient advocate who has a blog called Pharmacist Steve. Steve’s wife is a chronic pain patient.

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 represents 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.

 

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Jay Fleming

Pharmacist who refuse to fill prescriptions a few days early, don’t have any answers for patients when they tell them they won’t have their medication for a week.

LYNN… maybe I never had to go thru a draconian audit because I routinely had people arrested when they tried to pass a forgery on me.. According to the head of the county Narcs.. I had more people “busted” than the rest of the other 12-18 pharmacies in the city/county all together. He would seldom find a “fake” Rx in my files.. unlike most of my competitors. In my practice, I took care of legit pts and took really good care of those who tried to pass “fake paper ” on me. One time, I even had the Mother of one of the local bad boys arrested because he sent his Mother in with a fake Rx. Another time, someone tried to call in a controlled med – saying that they were from the local doc’s office.. and wanted it delivered… the head of the Narcs took the delivery for us.. and arrested her at her front door. I may have never had a draconian audit.. because .. I was fully aware of my corresponding responsibility that has been in the BNDD/DEA statues since the beginning in 1970.. and maybe the local narcs ran interference for me with the DEA… because I was doing my due diligence and acting professionally and responsibly and the local narcs had my back. Of course, this was my own independent pharmacy and had no conflicting corporate policies with my professional discretion and decisions.

Lynn

Tomato said: This RETIRED pharmacist (Steve) is clearly out of touch and has never endured something called “audit.”

Exactly. The RETIRED pharmacist didn’t work in a Govt Police State controlled and terrorized by psychopathic/narcissistic Alphabet Soup Agency Control FREAKS. It used to be FREE country where people had COMMON SENSE AND COMPASSION

BTW: This same rude pharmacist control freak issue of not filling a prescription for a schedule 4 weak weightloss drug prescribed by a diet clinic happened to me at Walgreens. They were very cold and robotic, almost as though they had no soul and would not fill my prescription. I have not had ANY prescriptions filled in 25 years! And I look like a typical slightly overweight, middle class well dressed lady with class and basic courtesy. I’m not some toothless crack addict but that’s how they treated me. I asked for my script back after being humiliated in front of other customers and after being asked every question under the sun and the compartmentalized robots asked me for my birthdate AGAIN (after they had already asked me when I handed it to them initially before making me wait ONE HOUR to tell me they would not fill my script). They would not give it back without asking me my bdate again. This is utter Draconian Nonsense. The alphabet soup agencies and the control freak government are the ones behind it all but it’s really strange how most of these pharmacists and techs in the big chain stores seem to be devoid of humanity. I took my script to Freds pharmacy and they smiled at me, made friendly small talk, complimented my suede Sherpa coat and handed me my prescription diet pills. Good GRIEF at what this country has become!!!!!!!!! It’s shameful

Mercedes

After reading all of these comments I would also like to input some information. I have a condition that is called reflex sympathetic dystrophy as well as the fibromyalgia. I had a below the knee amputation and no feeling at all whatsoever in my left leg. I have a neurostimulator implant and unless I have someone to pick me up and put me into my wheelchair I cannot leave my room, so I have to have someone pick up my medications which means that I have to go off of their schedule as well as my own. Pharmacist don’t seem to understand that the individual getting my medications may not be available on the exact day that it is due, so if they show up two days early it’s because they are not available the day of, and when I speak to a pharmacist about my medications he tries to tell me have you tried other medications beyond narcotics so I ask him did you serve your Country for 12 years to deal with all of this debilitating pain to have someone tell you that you’re a junkie, no sir I am not a junkie I am a veteran that is in excruciating pain and deserves more respect than I am receiving from the so-called pharmacists in this country. Pharmacist need to realize they are not God they are not MDs they had no right to tell me how severe my pain is. They have no idea what I go through on a daily basis and until they live A day in my life with my pain they have no right to tell anyone they can’t fill their meds two days early.

fmw

I am a pharmacy technician and i know i am going to get lashed at for stating the obvious but this”individual” is the exact reason why we have issues in our profession. He/She should have had an issue in the month of November being that the RX was filled 2 days late. Withdrawals, pain,lost work, etc, but because she/he was accustomed to getting med’s 2 days early didn’t really have that feeling of panic. Now being told cant have it for 2 more days, really sets this individual off.I am sure that patient wasnt pleasant nice and its very frightening for the staff when they get news that they dont want to hear. They are verbally abusive and some of these patients are the nicest people otherwise and sometimes its not even our fault. Insurance and the Drs write dates on them. We cannot pick and choose who we can give meds early to, that would cause a whole set of other issues and also if we did make an exception this month they would expect it next month. On the other hand we have the customers that come in every single month withe much the same RXs and they know exactly the rules and regulations and when it comes to and issue with med not in stock or insurance or they are going away or any other issue we have gone above and beyond to make sure that they have what they need and are not without. That my friend is the difference is the difference between the two sets of customers. True chronic pain suffers who are managing their pain AND chronic pain suffers addicted to the medication and managing their pain from 1 pill to the next 1. I have compassion for both and i do not discriminate as i feel more sorry for the latter as the are always in fear of being cut off and i blame the DRS and lack of education.

Andrea Lambert

PHARMd,

The pharmacist working with the patients dr sounds reasonable. However, my Dr. has called multiple pharmacies on my behalf and they tell the Dr they will not fill my meds. Doesn’t matter if the Dr. Contacts the pharmacy or not. They decide who gets their meds and who doesn’t. I was prescribed a slow release and one for break through pain and no pharmacy will fill them. All of the ideas from the pharmacists and techs sound great in theory but it’s not our reality! If it was that simple there wouldn’t be hundreds of thousands of pain patients posting on the Web desperate for help and their pain would be managed..unfortunately, our reality is that we are not receiving the medical treatments we require to live a somewhat “normal” pain free life.

Andrea Lambert

RPH you’re so incredibly ignorant!!! It’s a free country so go to another pharmacy?? Duh..that never occurred to use “dumb ass” pain patients..why don’t you try going to a different pharmacy and let me know how it goes! I’ve done the pharmacy crawl for hours a day..even after a 9 hr spine surgery I couldn’t get my meds. We’re discriminated against at every pharmacy in Florida! Unless you’ve gone through the humiliation of going from pharmacy to pharmacy and being treated like a junkie and given the “look” by every employee in the pharmacy keep your stupid ideas to yourself.

Amy

I Am a chronic pain sufferer. I also respect rules and regulations. Several so called pharmacists and techs who have commented on here have illustrated clearly the discrimination myself and other chronic pain sufferers face on monthly basis. You were very quick to point out addict traits as reasons for someone to try and fill a day or two early. But how about the situations that the pharmacy and pharmacist create? For example you try to fill early because every month your prescription is delayed by reasons such as the pharmacy doesn’t have it in stock or you have to hold the prescription 24 To 48 hours? When my scripts were being filled by local pharmacies there was never a month and my meds were not delayed. in response to the arrogant Writer who asked the question about taking meds less than prescribed, do you not understand what chronic pain means? There is no such thing as a good day! patients are also well informed. We understand that pharmacists have discretion. However they don’t seem to use it appropriately. They are quick to blame rules and regulations but unable to provide explanation when their answer is No. That is a weak response. I am grateful that I no longer have to deal with local pharmacies. I am happy to report I now receive my medication regularly without incident.with the assistance of my insurance company and my practitioner I no longer have to support local discriminators or their corporations.I also have no intention of letting go of the consistent profiling and harassing behavior that I experienced in my dealings with these so called professionals.fortunately now that my pain is being managed as my Educated medical practitioner sees fit, I can focus on seeking justice for myself and others that have suffered through pain, withdrawal and idealized thoughts of suicide to escape chronic pain.

Mark ibsen

Dave wrote: “The refusal of a pharmacy to fill a prescription for an ADA patient is a violation of Federal Law…if this is the case for someone you know, please have them go to http://www.ada.gov/t3compfm.htm to file a complaint…there is a substantial fine for the business and the individual pharmacist for such violation!”

Donna- FFPCAN

From all I have read here on this article page from pharmacists, and NOT Steve Ariens. It seems to me that many of the pharmacists who are working these days, needs to quit working pharmacy. They sound as if their stressed out and their hearts aren’t in this line of work for patients anymore but care more about what the DEA and the powers that be are more important than the patients. They don’t sound like they care about the patients welfare, only what the DEA says or their Corporations say. You should be speaking out for the patients who you are supposed caring for. Why in the world would anyone want to work a job that causes them such stress and make you turn away people who need you to help take care for them. Isn’t this why people enter the healthcare field? To help sick and pain people? I have read so many comments here and on several pharmacy groups and it’s obvious they are making jokes and in fun of patients who need pain medications. I thought that pharmacy was supposed to be apart of the healthcare system? Well.. just take a look at some of these groups on face book, websites and some blogs.. They criticize and complain about patients whenever they can. These people shouldn’t be considered anything in the nature of doctors.. They are cruel. They view pain patients as addicts, Drug seekers, etc.. No matter what their conditions are. Some people can’t get out of their cars and use the drive through because they have bad legs, had surgeries and so many more problems that I can’t even start to explain here. But?? They ARE judged, profiled and discriminated at every turn.. I have heard this many times..I have a pain advocacy organization and I get emails everyday and hear these very sad pain stories every single day about how these people are refused their medications and are left withdraw. It’s extremely bad right now with the holidays upon us. I hope these angry, miserable pharmacists are can sleep at night knowing what they are doing.. I hope you holidays are miserable! **If you are a pharmacist in the state of Florida? I can promise you that your treating these people horribly and most of them are legitimate and innocent!! The rogue doctors and pill mills in this state no longer exist! Most Pain doctors in this state are totally legit and are doing all they legally can to take care of these patients the best they can. If you can’t see that Pam Bondi has cleaned up this state yet? Then your blind! There are no more pill mills!! If your patients are needing a larger dose? Then that’s what they need! If you don’t understand that, then you need some extensive pain management training. Chronic pain patients require more medicine than terminally ill patients because they are living and have a tolerance that can not be reduced. These patients will probably… Read more »

GH

I am disgusted at the “stuff” from everyone in this whole article. Everyone thinks they are RIGHT. Actually if we would go back to the basics of trying to help each other instead of belittling each other, there would not be this problem.
I AM a pain patient,have been for 22 years. It is ridiculous the way I have been treated. I have been questions as to what kind of disease I have–to what kind of pain I have….Then the PharmD had the gall to ask me if I really needed to take apain med and if sitting in an electric w/c was just a ploy. You tell me why pain patients are a little wierd. We have been treated as lepers in our own society. One PHARM D had the balls to tell me his mother had arthritis and was in more pain than me. What an ass—he didn’t know my pain and he sure as hell didn’t know his mother’s. She was afraid of him. When I was still able to nurse, I took care of her case, she was VERY afraid of him. No wonder he was so smart he lost his business because of the way he allowed his employees to treat people.

Harry RPH

Dear Steve,

Please talk to at least two pharmacist a day who is still practicing. Understand their frustration about narcotic prescriptions. Once you understand what we go through every day, then you will change the way you advice people.

Patient suffering from chronic pain must be on combination of long acting and short acting. Reasonable ratio is 75% long acting and 25% short acting. They should follow opiate conversion chart while prescribing different opiate.

Filling controll prescription 2 days early is very reasonable and patient shouldn’t complain. If quantity prescribed is not enough for month then they need to talk to prescriber for higher qty or change in therapy. Once again don’t complain about pharmacist for not filling prescription early.

Many time I hear that oh I had a bad day and I took extra. Don’t you have a good day sometime when you have to take one less pill?

Steve please use your platform to guide patient on what to expect from modern days pharmacist. We put patient first but it doesn’t mean that we cater unreasonable requests.

Raymond Mac

I’ve been going to a walgreen, same store for about 5-years here in florida. I’m with NPI National Pain Institute.
I’ve go turn in my regular monthly script for Morphine Sulfate 60mg ext release. I get a call on the phone by a pharmacy tech saying my name, in tears that the brand new pharmacist will not fill this script, even though I get all 9 of my scrips a month, filled here. Only 2-scripts are from NPI for opiates. The remaining are a combo of blood pressure, etc, etc.
So, I ask to talk to this pharmacist. She proceeds to tell me I don’t meet a new guidline, good faith dispensing thing. I ask her which “rule” do you think I broke?. She says, I don’t have to tell you.
Ok…..now, I take this same script, after going & getting it back, and go to another Walgreen, 4-miles down the road…..
I go in, put my script on the counter. I ask for the Pharmacist. He comes over & I tell him a new pharmacist where I go & have for years, refused to fill. He takes script, looks me up on the computer system, and says to me, Sir, I honestly can’t see why she wouldn’t fill it. Guess what. This pharmacist filled it. He did say he could not remove this “mark” against me, which he (a pharmacist for 16-years), said he saw everything was in order.
He actually told me (I have names, dates, time), that I should try Publix. So, now Publix gets my approx 2,430 of my money, on my visa, PLUS, what my Humana supplement to medicare pays.

Rick

Wow…well, this has to be the absolute worst reply ever to a question of this nature! Heck, as a *technician* even, I would look at their profile, see how long it had been since they last had that C-II medication filled, and despite what the doctor wrote as a potential fill date on the prescription, if it still early, I’d politely advise them that it wasn’t due to be filled again yet. There’s several amazing points you’ve completely missed in your response Steve. Not the least of which is why do you need it filled early? The fact that the patient is travelling really isn’t an acceptable reason, as a prescription can realistically be filled anywhere. Yes, the patient would need to allow some extra time to find a pharmacy that would be okay filling it, and doing their necessary checking, however this is not an insurmountable obstacle in the least. What then is your advise for patients who continually get these C-II prescriptions filled early, and easily have an additional 30-60 days supply on hand, at home, but still receive prescriptions from their prescriber? Hold on to those extras for a rainy day? Share them with friends and family who ‘are in some pain’? Please, let me know as a retired pharmacist what you think is the best way to handle a patient with all that extra medication on hand. Because this is what you are advocating for. For any patients reading this, this is honestly, absolutely, and without a doubt the worst pharmacy-related “advise” I’ve ever read. I wonder just how many pharmacies would be willing to fill ANY of Andy’s prescriptions after word got out about him hiring an attorney and bringing case against the pharmacy for their doing their job correctly. Also, filing any complaints about a pharmacist trying to “practice medicine” without a license is absolutely laughable at best, from everything Andy said in his original letter, the pharmacist and pharmacy are following their jobs. But, I would assume a pharmacist would know this, which truly makes me question any credentials Steve may have. If there’s a concern about when/how you are receiving your subsequent fills, please do yourself a favor Andy…ignore everything those so-called ‘pharmacist’ advised, and speak calmly and rationally with your local pharmacy staff. They can help explain to you more about medication schedules, laws, etc surrounding your prescription fills, esp for your chronic pain. Heck, I’d be happy to help myself, if you read this, and care to leave an email or anything of that nature to contact you by. To Andy, I hope you are a smart, rational person who ignores everything Steve advises in his response, and a find more appropriate, and sane, course of action to take. To Steve…well, you brought laughter to my day. In copious amounts. I have the greatest difficulty in believing, after your response, there is any validity to the fact you are or ever were a pharmacist, or ever stepped foot in a… Read more »

Yanya

As someone who suffers from chronic pain, I know what a lot of people are talking about when they say they feel mistreated and judged by Pharmacy Staff. This normally isn’t because they like judge people, but because they have to judge people. There are laws to follow and they can get in trouble for filling scripts for an addict. Pharmacists are under a lot of pressure from everyone. I would say your best bet is to stick with one pharmacy. It might take a bit to get established with them, but it’s completely worth it.

mg stuart

I am a chronic pain patient. I understand all of the comments about filling prescriptions early. BUT WHY is in here in Florida that its difficult to get a pain med filled at all? I do not look like an addict. I go to respectable physicians. I’ve been turned down at CVS & Walgreens for no reason at all.
I wish the pharmacists reading this would understand that there are many patients out there that do NOT abuse drugs, that just need pain medication to live a somewhat normal life. When I don’t have them, I can’t do anything but stay in bed. It truly is not fair. Any suggestions?

Jay, RPh.

And just to throw another issue into this debate…we actually have pain clinic physicians who require that we calculate the 30 days since the patient received their last prescription and are adamant that we not fill the new rx until that date regardless of the date that they may have written. Lest we get an earful from the physician.

You sir sound like an ***** when you come up with that kind of response. The better answer was to tell him that pharmacists are unfortunately more often regulated by laws rather than what you seem suggest is only common sense. You needed to explain that every state has different laws governing controlled substances that pharmacists are bound to follow. You are correct that many RPHs do seem to take that to an unreasonable extreme which years of experience eventially tends to quell. Nothing in the world is “that” serious for goodness sakes. But I will say that the best advise for him instead of your ridiculous rant is : TAKE YOUR RX SOMEWHERE ELSE!!!!!!!!!!! Its a damn free country and CVS is not the only pharmacy around. And no, his RPh would not mind that one bit!

KC

Chronic pain patients are in PAIN 24/7. Their worst fear is to run out of meds, especially while on vacation or on a business trip. I’m a planner, an organizer, one who does the “what if” scenario…..what if I drop a pill ohey have n my kitchen floor? that’s 1 less pill I’ll have while on my trip, g an. I can fill my blood pressure meds ahead of time, but not my pain meds. I hate this system. It falls back on the DEA and insurance co’s who are forcing pharmacists to turn people away. how can anyone who goes to cvs have a relationship with the pharmacist??? It’s rare that I get the same pharmacist twice. Each pharmacist acts differently, but the 1 thing they all have in common is that they don’t care about a patient. the system has turned them into police…and many jump to the wrong conclusion & think chronic pain pts are addicts.Pharmacists have become control freaks. By not filling an rx early so I can take my trip with peace of mind, you’re forcing me to go to another pharmacy & another & another til I get someone who will fill it. and then this behavior is a red flag because I must be an “addict” in their eyes. no, you don’t know the amount of pain I’m in 24/7 & how great my fear is of running out of meds & not being able to get it filled. y’all don’t know what its like. if you did, pharmacists and dr’s would push back on the DEA and the system.

Cpht

So you got a 90-day supply for a 30-day trip? Why? Just so you’d have a story to show it CAN be done?
And where did you get that he was “going without his meds for 96 hours” at the time he wrote the letter? I may only be a tech, but even I can do the math that says that, if he got the previous Rx filled on Nov 6, he wouldn’t be out until Dec 6, not on Dec 2, when he went to fill the Rx. Meaning, he wouldn’t have been “out for 96 hours” until Dec 10, which is TOMORROW!!! Nowhere in the letter did he state he wouldn’t be in town on Dec 4, nor did he state he would be nowhere near another pharmacy on that date, so your “without meds for 96 hours” is purely inflammatory conjecture (like much of your answer). In fact, I’d be willing to bet he went back on Dec 4 & filled the Rx with no issues.
You’re also obviously unaware that many insurances are now keeping track of how many tablets a patient has received of a particular med and refusing to cover fills until they are down to 2 days’ worth of meds from ALL previous fills. Since you’re “retired,” I wouldn’t expect you to know CURRENT insurance practices. Although, if you’re going to recommend recourse to people based on CURRENT policies, you might want to educate yourself. Oh wait, you don’t needs to do that, you’re “Pharmacist Steve,” you just recommend suing! Let their attorney educate themselves (and possibly get their client blackballed from every pharmacy chain in town). What do you care? As long as you are being heard, right?

Kevin C., PharmD.

I am very compassionate to the needs of a patient with chronic pain, but the issue that most pharmacists responding to the article is the one-sided assault about our profession, especially coming from someone who has practiced. Pharmacists, especially in the last 10 years, have a vast amount of clinical experience and knowledge compared to pharmacy school in the 60s or 70s which is when Steve probably graduated. There are some many holes in this story that it’s hard not to be frustrated. It’s the very thought process of most patients hat makes retail pharmacists protect their careers and not focus more on patients. Threats of lawsuits, filing complaints, audits add more to the friction of the bond between patient and pharmacist. When the true value of the pharmacist in healthcare is realized, the stigma of the glorified “pill pusher” will continue to drive a wedge between that relationship. While it is very unfortunate that patients sometimes cannot obtain the medications to due a variety of circumstances, it is a reality today. Just remember that 1 day, you might bring a prescription to be filled and that local pill pusher, might be your last defense in preventing a life-threatening drug interaction, that your brilliant physician would not care or know about since they only take about 1/2 semester of pharmacology.

PharmD from Louisiana

@Pat Anson, I would encourage you to drop Steve Ariens from your “Ask the Pharmacist” column and replace him with a currently practicing PharmD who is knowledgeable about pain management. Mr. Ariens has clearly not been practicing pharmacy for a while and I feel that the profession of pharmacy has left him behind. It is clear to me that Mr. Ariens considers himself more a “patient advocate” than a pharmacist, and that the only reason he continues to call himself a pharmacist is so he can use this title to bully other pharmacists into serving his own agenda. If Mr. Ariens wants to be an advocate for chronic pain patients that’s all fine and good, but not under the banner of “Pharmacist.” By allowing Mr. Ariens to call himself a pharmacist and then suggest to your readers that they should expect pharmacists to just blindly follow doctors’ orders is not only doing a disservice to our profession, it is doing a disservice to the chronic pain patients who make up your audience. Encouraging the patient to hire a lawyer and file complaints to corporate, the state board of pharmacy, the insurance company, and human resources is inflammatory and does not help the patient. What needs to happen is the pharmacist needs to work with the patient and his physician to make sure the patient is getting the proper treatment he needs. I hope that Andy in Alabama will ignore the unprofessional advice that “Pharmacist Steve” gives and seek the advice of a true professional.

SeRPh

Almost none of you really know who you are talking about here. Steve knows more about pain management than most of you ever will. Those of us with more than a few years on our PharmD’s (and the fact that Steve is retired means he’s got that experience in spades) realize that patient care isn’t as simple as arithmetic.

We are supposed to be in this for the patients, not in spite of them.

Yes, yes short acting opioids aren’t good for chronic pain management.

Yes, we are doctors with tons of knowledge about pain management.

BUT YOU DON’T MAKE A PATIENT SUFFER WITHDRAWAL JUST BECAUSE YOU AREN’T SURE. Patients come first, always.

And it disgusts me to see some of you outright insult Steve, who has shed more blood, sweat, and tears elevating this profession from the “lick, stick, count, pour” days than any of us ever have. You probably are too busy chasing your metrics to please your DM than to know the likes of Steve Airens, Jim Plagakis, David Stanley, or Eric Cropp.

Its all well and good to crow about our doctorates, our knowledge of the law, our authority in the pharmacy. But unless we use it for the benefit of our patients – and the possibility of putting a patient through withdrawal is not for their benefit – then what good is it?

Suchanh Chung

Mr. Steve Airens needs to go back to those “ivory towers” to really learn control substance laws. Slandering of another pharmacist and inciting a litigation? Each and every day pharmacist continue to care for patients upholding Hippocratic oath to the best that we can. We can only abide to the rules and regulations of countless regulators including DEA. Having retired you should have sought your peer review before you hastily slander a fellow colleague in the matter in which you did. I hope this message finds you so that you can reflect on your letter and the profession that you once hold so dear.

PharmD

“When a pharmacist posts comments that are disrespectful of patients, you are only confirming their worst impressions of your profession.” -National Pain Report Editor, Pat Anson.

Your website has already done a good job of this. Many articles on this website are disrespectful to pharmacists and doctors and are only confirming our worst impressions of chronic pain patients. As pharmacists we are simply trying to set the record straight to an article that is full of misinformation. If you are going to publish articles like this, be prepared for the backlash. I would also recommend having a pharmacist on staff that is up to date with current rules and regulations. You are allowing a “professional” to publish lies on your website.

PharmD No BS

Steve RPh (Clearly out of practice for a decade and not PharmD), It is beyond irresponsible for you to suggest Andy lawyer up and contact Alabama BOP because you do not have a clear understanding of the thought process of filling opioids today, nor the circumstances as to why his prescription was denied. I will explain four main reasons as to why your response is TOXIC to the practice of pharmacy (today, not 1988). 1. First and foremost: you do not treat chronic pain with short acting opioids. Andy never mentions an extended release opioid Rx being denied. Shouldn’t this throw up a bit of a red flag right from the start? The fact that he chases his pain with Norco around the clock is a clear sign his pain regimen is suboptimal therapy. Long acting opioids reduce the risk for addiction and drastically reduce the number of short acting opioids needed for BREAKTHROUGH PAIN. This alone voids your argument but I shall continue on. 2. Because Andy does not receive extended release opioid he is assumeably taking his Norco around the clock leading to this situation every 25-30 days. The pharmacist probably ran a PDMP and found that Andy is about 3 days early every fill. Translation: in every calendar year Andy receives 13 months worth of prescription narcotics. We look at the trend, not a black and white number of days early per fill. We understand there are extenuating circumstances, but all of Andy’s are a result of terrible pain management at the most basic level. Moving on… 3. If I were the pharmacist on duty, I would have found out where exactly Andy was traveling and arranged for his Rx to be filled at a CVS there. As he stated, CVS is a national chain (we won’t get into their foul play on pilling tobacco products then recouping their lost sales in penalizing the rest of us). We can arrange for such things from state to state when explained by another healthcare professional. Andy probably hops around but given the circumstances I always side with what is in my patient’s best interest and will sacrifice what little time I have to make sure he doesn’t suffer (even if I disagree with his current therapy). 4. I call and speak with the doctor directly. Explain how to go from crawling to walking in terms of the most basic principles of pain management. Then I’ll give him/her all the information and facts they need to get his previously crippled patient to a functional human being that doesn’t watch the clock to see when he can take his next pill; after he’s already in pain. Hell, I’ll even come to their office and outline what they should doing in order to serve the best interest of the patient. After all, most of us are doctors and our professional judgement is often not only valid but BETTER than the prescriber in this situation. Yes, I just said that- the AMA might… Read more »

Sue

It’s truly unfortunate that opportunist doctors and drug addicts have made my profession a legal babysitting profession, spending a ridiculous amount of time investigating chronic doctor hopping/pharmacy hopping trash. Not the profession I signed up for but it is what I am forced to work with on a daily basis until retirement. Not much more than glorified bartending anymore. The professionalism has all but been lost on our narcotic/benzodiazepine/muscle relaxer abusing customers. Sad sign of where our country has gone.

Jeanne Hyatt

I agree with Pat Anson and thank him for explaining to all of the pharmacists who wrote disparaging comments to Pharmacist Steve’s article. Obviously none of you have ever been a chronic pain patient in the State of Florida, where every single chronic pain patient is suspect, every single month, when they attempt to fill every single one of their legal and legitimate prescriptions. Guilty until proven innocent or something like that. I am not talking about drug abusers or drug addicts; I am talking about legitimate chronic pain patients who need their pain medication to function. Someone mentioned how odd it was that we pain sufferers are always right there every 30 [or 28 or 29] days to get out prescriptions filled. I’m sorry but the answer is staring you right in the face. WE are IN PAIN! Every.single.day.of.our.lives! So, it sorta “IS” kind of important to us. I wouldn’t wish chronic pain on anyone but I certainly wish you pharmacists would show a little compassion towards us when we come in not knowing if you are gong to say Yes or No to us. It sort of matters. I have more respect for Pharmacist Steve, sticking up for the sick, the ill, and the people in pain, than I do for the pharmacist who treats me as a criminal based on my particular ailment [ie: because I present a pain prescription to them]. I realize all this is because of pressure from the DEA that is causing you all to be so strict and that you must protect your licenses but I am sick to death of having to do the pharmacy crawl to 6 or 7 or 8 pharmacies every month because “You do not feel comfortable filling”. You don’t understand how uncomfortable it is to be writhing with pain only to be told it makes you “uncomfortable” to fill our legal and legitimate prescription that we have sometimes, for years, come to the perfect dosage and combination with our doctors. You don’t understand the strict regulations and hoops we must jump through in order to live the normal pain-free lives that you are lucky enough to live. You don’t understand that we are intelligent adults who are quite aware of the dangers of the medications we take and have good working relationships with our doctors. You don’t understand that the pendulum has swung and now it is the legitimate patient who is told they cannot get their meds, not the junkie. And you don’t understand what it is feels like to be told you can’t have the only thing that stands between hell and a normal, pain free day. I think “that” is where Steve is coming from. He knows! He gets it! And he is trying to help us. It “is” a matter of civil rights at this point! Someone has to get back to basic human understanding. Someone has to stand up for “we”, the patient here as we are all in too much… Read more »

An Actual Pharmacist

I would like to point out that Steve is no longer a pharmacist, was never a Pharm.D., and would lose his job if he were still practicing. Pharmacists are caught between the DEA, MDs that overprescribe narcotics, abusers of narcotics, and legitimate patients that are suffering through pain. Establish a relationship with your pharmacist and respect his authority. Understand that if he were to “bend the rules a little bit” and fill that CII early, he could lose his job and license. Be responsible for your medications and understand that pharmacists are sick and tired of being the police of the medical world. Between Dr shoppers, Stolen Rx pads, Fake phone ins, The doc that will write anything for a fee, the thousand deadlines we face a day, the pissed off parent that their kids nasonex requires a prior auth, the corporate BS, the standing for 12 hrs straight and eating whatever we could scarf down while getting ready to give that next flu shot, and the guy that just dropped off 10 rx’s that are half legible that wants them in 15 mins “or i’ll take my business elsewhere”…. we would love to give up policing the medical world and let someone else take over. But we cant do that and we are here for the safety of the public.

soon to be pharmD

Dear editor,
The fact that after the overwhelming response contradicting the original post of this article you’ve decided to keep the article up makes me question this website all together. I challenge you to remove the response from said RETIRED pharmacist and replace it with an answer from a practicing pharmacist with a valid and current license. One of the first things we learn is that an article is only as good as its source, and your source for this article is a RETIRED pharmacist who’s clearly not up to date with the practice of pharmacy or pharmacy law.

also, this article only criticizes,threatens and belittles current practicing pharmacist and i think its safe to say that it is ok for pharmacist to react the way they are, if you can’t take the heat stay out of the kitchen, you posted an offensive article now deal with the consequences.

@Jenny you have a point and I acknowledge I made a mistake in letting that particular comment pass. I will not remove the article.

Mirella Parbus

Steve
REALLY. WE ARE NOT BEAN COUNTERS.. we are following DEA REGS that say <25% or three days.. ..also if we continually fill 3-4 days early after four months they have a built up stash of 9-10 days.. so where is their stash. . Oh wait it fell in the toilet.. Lol.. You need to remember what practicing pharmacy is about.. and our laws.. instead off teaching people you circumvent them. Fyi go ahead and sue me.. remember I. HAVE RIGHT OF REFUSAL TO FILL ANY RX..

Jenny L

“….I ask that you keep your comments civil and with no name calling. Otherwise your comments will not be published.” -National Pain Report Editor, Pat Anson.

“Too bad you can’t file a complaint for the pharmacist being a general PUTZ !” -Steve Ariens

Please be consistent with the rules or remove Mr. Ariens article.

PharmD

WOW! Is this a joke?? How did “Steve” ever even get licensed?

Martin

In South Carolina the law says that you can get control rx filled 2 days early once during the life of the rx. No gray area. No judgement call. Pharmacists have to obey the law. We don’t make the call or the laws.

As the editor of National Pain Report, I generally don’t make comments about comments from readers (this is your forum), although I will make an exception in this case. First off, I welcome the thousands of pharmacists who have discovered this website in the last couple of days. You are free to agree or disagree with Steve Ariens, but I ask that you keep your comments civil and with no name calling. Otherwise your comments will not be published. Secondly, please be aware that at least 90% of our readers are pain patients — many of whom feel they have been treated poorly by pharmacists. Look around the website a little bit and you’ll see what I mean. When a pharmacist posts comments that are disrespectful of patients, you are only confirming their worst impressions of your profession. That said, I know most of you are hard-working, honest, and respectful of your customers. Given the current regulatory climate, you are also working under difficult circumstances when it comes to filling prescriptions for controlled substances. We welcome different opinions and if a pharmacist ever wishes to write an op-ed explaining some of the issues that come up in dealing with pain patients, I would be happy to publish it. You can contact me directly at editor@nationalpainreport.com.

Anon PharmD

Filling a controlled substance chronically early illegal. When a patiently is consistently picking up a 30 day supply at day 28, they are accruing an extra 2 day supply every month. At the end of the year they have nearly an extra month of tablets.

Additionally “Pharmacist Steve” with regards to :
“Most of these pharmacists have a great deal of “book smarts” but little or no clinical experience with subjective diseases (pain, mental health, anxiety, depression, ADD/ADHD). All they know is what they have read in a book or they were taught by someone at college in an “ivory tower” who has more book smarts than clinical experience.”
is ignorant. Since 2001 pharmacists have completed doctoral degrees, with increased emphasis on clinical work. We are required to complete rotations in clinical settings. It’s bad enough the public degrades our profession but to have one of our own degrade it is sad.

Tomato

Why would you bring in an attorney while the patient still has enough medication on hand and able to fill the prescription on the date available? This RETIRED pharmacist is clearly out of touch and has never endured something called “audit.”

E. Vesely

As a current PharmD student and employee in a retail pharmacy, I found Steve’s response to be quite extreme. In this patient’s situation, yes it seems reasonable that he was surprised when he was told he would have to wait for his prescription to be filled. However, it has been my experience that many patients come in to fill controlled (CII nonetheless!) substances early and when told it is too soon, immediately fire back with a story of their terrible pain and need for the medication. What makes it more difficult, is that this gentleman was not a regular patient at that particular pharmacy location and therefore the pharmacist had no prior relationship on which to base and back up a decision that could put his job at risk. I have absolutely no doubt that the great majority of patients are being truthful and will honestly be in pain without their meds. Steve’s response, however, clearly highlights the reason why pharmacists are so very focused on dates, etc. In this inflammatory and over-reactive legal environment, pharmacists are at high risk for losing their jobs or being sued, no wonder they want to cover their own butts when they are being threatened with legal action for merely trying to exercise professional judgement as is their right and obligation. One final point, I believe it is of integral importance that patients educate themselves so that they are better able to understand the rules and regulations that may cause them to have difficulty in filling a prescription. That means everything from the simple legal rules of CII-CV medications and in understanding that the pharmacist doesn’t just decide it’s too soon to refill medications. In most cases, it is a decision of an outside party- either your insurance, your doctor, or the law. Ask your local pharmacist, ask your doctor, google it (find a reliable source, like a .gov!)…information is at all of our fingertips. Patients need to take ownership in their own healthcare just as much as providers and pharmacists do.

Kiki

I am shocked with the response to this patients letter. As a chronic pain patient, who is not in the pharmacy profession, even I know that if taken as prescribed, this patient should still have medication. In addition, there are very strict laws in place for narcotics and also, in most if not all cases insurance will simply not pay for an early script request. Requesting an attorney to write a letter and taking those steps against CVS and the pharmacist is laughable. Are you for real?

K

wow Steve really? Everything else aside, she wasn’t going to run out of meds. She still had two days worth. So what “96 hours” if suffering are you referring to?

Jeff

Wow, everything about that “answer” was completely incorrect, Steve. Sure, fill a pain med a week in advance, increase the chance of abuse. It’s controlled for a reason, I wonder why?

KY pharmacist

I would just like to point out that there is a difference between “may fill” and “must fill” and that pharmacists have always had the right to refuse to fill a prescription. For any reason.

mike

Wow.
Way to become part of the problem.
Maybe you should come out of retirement and retake the MJPE.
This is horrible advice.

Cynthia

Wow Steve. You are so out of the ballpark. I am a Doctor of Pharmacy and it is part of my profession to ensure the patient receives the proper medications and with controlled medications within an established time. I could have the designation of RPh and still this includes the above. We are health care professionals. You are out of touch with the profession of pharmacy. Learn from many of the professionals comments made previously.

Pharmacist in Florida

Steve,

You’re an idiot for more reasons than one. First off the law varies by states but restricts filling dates of controlled substances to after 80% consumption in Florida. With all of the drug diversion going on do you really want to advise patients that they have the right to fill controlled substances whenever they want? If a patient is chronically requesting to fill a pain medication early then the question becomes what is happening to the rest of the meds and if the dosage is not suitable this issue should be addressed with their physician. So filling the prescription early allows the patient to “practice medicine with out a license.” Even further if the pharmacy allows a 2 day grace period, I can guarantee from experience that patients abuse this grace period and have their prescription filled 2 days early every month. So by the end of the year they should have an extra 24 day supply, so advising them to sue the pharmacy is just stupid because if you can’t answer the question of what have you done with almost an extra month’s supply of medication over the course of the year then a filing a law suit is crazy. We are pharmacists, not drug dealers.

Kevin Curry

I just read this again because it is so infuriating. “file complaints with the Alabama Medical Licensing Board and Board of Pharmacy that the pharmacist is practicing medicine,” Steve do you even know WTF a pharmacist does? A cornerstone of our profession is checking orders for safety, efficacy, and appropriateness. This isn’t playing doctor, it’s being a pharmacist. If a doctor writes a script for #600 10mg oxycodone with a sig of 20QD would you fill it Steve? #1000, #10000?

Kevin Curry

This logic doesn’t even make sense. If you were late to fill your last script by two days, surely those two days November 4th and November 5th would have been the days you experienced breakthrough pain, because you had run out of the previous month’s supply. So now, you are on time for your next script, logically you have 2 days of pain medication left from the late script last month. This is the pharmacists understanding too. The “This will cause me pain” argument doesn’t fly with me, It almost incriminates you for misuse of the medication prescribed because if you took it as instructed you would have enough to last December 4th and 5th. If you’re having breakthrough pain at the end of the month bring it up with your doctor, not your pharmacist. And have them write an appropriate script.

You absolutely must realize that we pharmacists have the DEA breathing down our necks. We don’t want to play cop but to protect our own licenses we have to. I’m not about to sacrifice the license that allows me to bring a fat paycheck home each month so that you can have your CIIs early because you’re using more than you are prescribed.

Mike Fisher

Dear RETIRED Pharnacist Steve, you are clearly out of touch with retail pharmacy. So much has changed in the last few years and you have failed to remain informed before adding your two cents. This makes you the recipient of the PUTZ OF THE YEAR award. If you think that is using our training and questioning scripts is ‘bean counting’, then you need a new thesaurus that specializes in colloquialisms. It would be more appropriate to call us that if we blindly filled these scripts and questioned nothing. I have a suggestion, Pharmacist Steve, it’s time for you to retire from your second career. You’ve become outdated as a “journalist” too.

Forrest long

Steve made himself look pretty silly with this one. Sometimes it may be insurance that keeps a pharmacist from filling an rx early. The state you live in also has the ability to fine pharmacists who refill CII rxs early. Great job steve, you should have prefaced your response with “this is how things worked 20 years ago when I was a pharmacist”