Most of the people in the chronic pain community have three things in common other than their pain: they are emotionally, physically, and financially exhausted. They are all consumed with fighting their pain and the system that is interfering with them getting proper treatment.
Most want to strike out or sue someone – everyone — from the President to the DEA, Governor, Walgreens, CVS and on down the list. Whoever they believe is standing in the way of them getting the best quality of life they can obtain. All they wish to do is be the best spouse, parent, or employee they can be.
The DEA is putting out public statements that their function is not to interfere with a legitimate patient getting their needed medications. However, their actions and dictates with those in the drug distribution system (doctors, wholesalers, pharmacies, and pharmacists) seem quite contradictory to their public statements.
Apparently, the DEA has decided that the pharmacy is the last line of defense in the war on drugs and that it is the pharmacist’s responsibility to determine not only if a prescription is written by a properly licensed prescriber, but also if the medication is medically necessary for the patient.
This requires access to the patient’s entire medical records and a diagnostic skill set for a wide variety of disease states. Which few, if any, pharmacists have! Pharmacists are “drug experts” not diagnosticians!
To date, there seems to be little interest by anyone in the legal community to step up and assist those in the chronic pain community to make the DEA and other bureaucrats take a step back from all of the opiophobic regulations that have been implemented; and all the other players that are interfering with patients getting their necessary medications.
Most of the pharmacists – especially those employed by the chain drug stores – are just employees. Their negative opinion of filling opiate prescriptions are fueled by the “book smarts” that they obtained in college, the indoctrination that the media shoves at all of us every day, and the mandates from their employers. Like trying to avoid being fined by the DEA, mostly for poor record keeping.
If you have some sort of insurance, then you have a contract with that insurance company. You are paying them a monthly premium for them to provide payment to a vendor for a list of medical product and services.
That pharmacist you are dealing with may have never seen the contract between the pharmacy and your insurance company. In that contract, it normally states that the pharmacy cannot charge you cash for a covered prescription and/or refuse to bill your insurance company for your covered prescriptions.
If your drugs are paid for by Medicare Part D or Medicaid, then there is federal money involved.
So there are potentially several layers of contracts involved: the Center for Medicare/Medicaid Services (CMS), your insurance company, the pharmacy and you.
You have paid your premiums as your part of the contract, the pharmacy has agreed to be part of the insurance company’s network, and the insurance company has agreed to be part of CMS network.
If the pharmacy is refusing to fill your prescriptions, then they may be in violation of their contract with your insurance company. The insurance company may also be at fault, for not making their contracted pharmacies live up to the contract. Or the insurance company may be in violation of their contract with CMS.
There are bureaucrats in place to help “make you whole.” First, contact your state insurance commissioner. Here is a website for the National Association of State Insurance Commissioners: http://www.naic.org/state_web_map.htm
If your drugs are paid for by Medicare Part D or Medicaid, here is a website where you can file a complaint: http://www.medicare.gov/claims-and-appeals/file-a-complaint/complaints.html
There may be state level complaint forms for Medicaid. You can your social worker for this information.
These bureaucrats do not come out looking for violations, but they are there to assist you in making sure that all the rules that apply are not violated.
But first you have to file a complaint.
Steve 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.