Yesterday I received this letter via fax from a Walgreens Pharmacy:
Dear valued prescriber,
Walgreens wants to ensure that our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances. Our intent is to partner with you to ensure that patients receive their appropriate therapy and that the necessary information to confirm the appropriateness of the prescription is documented to satisfy DEA requirements. This process is designed to protect both you and the pharmacist.
According to title 21 of the Code of Federal Regulations... [statute quoted]
Our pharmacists are required to take additional steps when verifying certain prescriptions for controlled substances. This verification process may, at times, require the pharmacist to contact you for additional information necessary to fill the prescription. While the information requested may vary, potential questions could include information about the diagnosis, ICD-9 code, expected length of therapy and previous medication/therapies tried and failed. Privacy laws allow you to share this information with other healthcare professionals providing care to this patient.
We realize that this process may generate questions and concerns from both you and the patient and we will do our best to respond in a professional and courteous manner. We recognize that sharing appropriate information with our pharmacists may require additional time from you or your office staff and want to thank you in advance for partnering with us to provide the best care to our patients.
Your Walgreens Pharmacist
Yesterday too, perhaps as a result of this new policy, a Walgreens pharmacist refused to fill a prescription for buprenorphine I had phoned in earlier. When I contacted the pharmacist a second time, she advised me that because the patient had apparently used the prescription faster than directed I must alter the prescription before she would refill it. I refused, and instead filed a complaint against the pharmacist with the state Board of Pharmacy. I ordered the refill from a different pharmacy.
I attempted to contact the Walgreens media people for an explanation (The fax included no contact information.), but the company representative's outgoing message stated that she will not return for several days. However, many physicians seem to believe that Walgreen may have implemented these new rules after getting in trouble for accepting fraudulent prescriptions.
Regardless of the impetus behind this change, what we see here amounts to another cynical exploitation of physicians' concern for patients, literally holding the patient hostage in order to manipulate the physician. Whether or not physicians charge patients a fee for participation in this gratuitous exercise, it will accomplish little other than raise the overall cost of health care. Pharmacists certainly should take reasonable steps to assure the legitimacy of prescriptions for controlled substances, but they have no legitimate need to review the patient record, nor are they qualified to do so. This includes diagnosis, ICD code, anticipated duration of treatment, and history of other failed treatments, information typically demanded for prior authorization for insurance reimbursement. If the pharmacist only perfunctorily collected this information prior to dispensing the drug it might only waste time, but I can easily imagine a pharmacist playing doctor by pressing me to try a different medication first.
Pharmacists should focus on following physicians' orders and stay clear of activities for which they have not been trained. To address the problem of fraudulent prescribing we should follow the lead of New York state and require electronic prescribing of all controlled substances. Continued use of paper prescriptions, telephone, and fax makes it easy for criminals to fool a pharmacist.
We can fight this unwarranted intrustion into medical practice:
- Refuse to order pescriptions from Walgreens and any other pharmacy that requires you to provide the information listed above.
- Demand signed authorization for release of information from the patient and collect the statutory fee before providing records to a pharmacist.
- Providing such information to a pharmacist never constitutes an emergency. Take your time.
- Charge patients a fee for participating in a telephone discussion with a pharmacist, like you might for prior authorization.
- Inundate your state's pharmacy board with complaints.
- Use social media. Tweets that include @Walgreens will get the company's attention.
- Post a sign in your waiting room indicating that you will not participate in prescribing at Walgreens.
Dr. Dad goes even further.