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

(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 pharmacy

They 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.

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