An Invitation from Art Levine, reporter for Newsweek and other major media outlets

5 Responses

1. 

   Holly Davidson, on December 23, 2017 at 3:24 pm said:

   Wow! UNREAL!

   Reply
2. 

   Plow, on December 22, 2017 at 10:16 am said:

   Criminal what the CORPORATIONS are now allowed to do. Everybody out there needs to realize that Republications are the party who loves corporations!! Remember what Mitt Romney said, “coroporations are people my friends.”

   Reply
3. 

   Karl Deigert, on December 22, 2017 at 6:39 am said:

   If Walmart ascertains that a particular store is dispensing a percentage of controlled prescriptions greater than 15+\-% of the total Prescriptions filled they believe that this will draw unwanted scrutiny from the DEA. In December 2015, at my particular store in Fort Myers, Fl. (Sam’s Club but under supervision of Walmart Compliance Department) it was determined that my percentage had reached 22%. I was told that I was number three in Florida with two other stores, Sarasota and Palm Beach being at 24 & 27 percent.
   To “fix” this, on January 14, 2016, the Compliance “Director” from home Office in Arkansas, along with my direct supervisor, held an impromptu conference call in my store , without preamble, with three other Pharmacists present plus myself and my staff pharmacist. In this 90 minute call, the director laid out and drafted, with input of the others, I remained silent, a haphazardly prepared “Guideline” that was to mimic the CDC guideline that had not even been formally completed at the time. It was NOT a Guideline but rather a mandate as the director stated at the beginning of the call “if you don’t like what we will be doing here today you should go practice elsewhere” implying retribution if not adherent to the Guideline. At the end of the call, I objected vehemently to the “Guideline” and stated that the parameters could potentially harm patients. It was implemented immediately this same day after the call ended. On the day of the call, I had never even heard of the forthcoming CDC draft. Immediately, I began a fact finding mission and seeking remediation of the new mandate with corporate officers. I also began reporting the unlawfulness of the mandate to regulatory agencies.
   The primary parameters caused for the immediate dismissal of many patients that had patronized this particular store for many years prior to my becoming manger. The elderly, sickle cell, chronic pain patients all indiscriminately refused care. It coerced refusal of validated and legitimate prescriptions based on ambiguous parameters. Seeking clarification, I was told the parameters were to be interpreted as black and white and I was to take ownership of the parameters. This mandate removed and usurped my Pharmacist’s professional judgment, an act disallowed by ANY entity by Florida law, coercing me to refuse Medicare, Medicaid, and Disabled Patients’ Prescriptions. Again, the mandate was not applied company-wide just at my single location. I learned then that the other locations also had a mandate installed by similar circumstances; but, when I compared my mandate to theirs their were significant differences. The ONLY reason for implementation was to squash the number of controlled prescriptions being filled. It was effective and daily total RX volume plummeted.
   The primary parameters that coerced refusal were:

   2. After 60 days the patient MUST seek treatment from a “Certified” Pain Specialist:
   -What defines certified?
   -The exclusive requirement of the guideline is that the doctor must be “Board Certified” in pain management. The corporation has provided just three methods to verify the status of a doctor: websites ABPM.org or ABMS.org (certificationmatters.org) or the doctor office may fax a copy of the doctors Board Certification. No other sources are to be considered. Doctor membership in these organizations of course is voluntary and not mandatory to prescribe and write valid prescriptions subsequent to a valid doctor/ patient relationship as allowed by Florida law. Doctors whose names are not returned in a website search must be excluded at my pharmacy. Doctor names that do appear on the site with a certified specialty BUT do not have PAIN listed as a specialty must be excluded. Additionally, all doctors that maintain a PMC registration with Florida but do not appear in the web searches must be excluded. The State of Florida DOH database for license verification is excluded from use. The DOH site lists doctors’ areas of specialty but is excluded and the fact that the doctor has registered as a PMC, meeting all the prerequisites to do so and qualifying the doctors’ prescriptions as valid to fill must be excluded. Board certification in other fields of medicine (surgical services of any type, anesthesiology, oncology, orthopedics, podiatry, etc.) are excluded from consideration but these same Board Certifications exempt these doctors from having to register with the State of Florida as a PMC. The exclusivity of “Pain Certified” will exclude the majority of doctors and subsequently result undue restriction in the access of pain medications.

   3. ANY patient using an immediate release opioid (IRO) for greater than 60 days MUST transition to an extended release opioid (ERO) AND ONLY use IRO as supplement to ERO
   -60 days?
   Chronic pain per CDC is >90 days so why the 30-day difference? Is the 60 days a continuous period or a cumulative 60 days and over what calendar span? Do I need to turn away a patient that under uses an IRO on an as needed basis, and has done so for years to obtain quality of life, because it’s greater than 60 days? Nonsense!
   – MUST use ERO beyond 60 days?
   What about that same patient above who is getting the IRO for > 60 days AND is already under the care of the requisite “Certified” specialist? Is the corporation now dictating how that certified pain specialist is to practice medicine and care for his patients? How can the guideline determine what specific patient is a candidate for ERO therapy? Many studies show that IRO therapy alone is as effective as ERO plus IRO therapy. Many patients cannot perform well in activities of daily living while using EROs due to side effects. Patients on IRO therapy alone can achieve adequate pain control through self-titration. If the concern of the guidelines is safety, then the fact that most overdoses occur with EROs should be considered.
   -…IRO ONLY as Supplement to ERO …?
   What of the patient that is in a healing process and may be able to transition from ERO/IRO back to IRO only therapy? Is this patient negated from ever getting IRO therapy again because 60 days has been exceeded?

   -IRO vs. ERO?
   What about METHADONE which can have a very long half-life and pain relief of 6-8 hours? While not extended release it is often used as the primary pain reliever with another IRO for breakthrough. This patient will be excluded from care based on this use of methadone and the guideline.

   3. IRO medication therapy >60 days (with mandated ERO therapy above) cannot exceed #120 per month
   -#120? the figure is not defined
   -Is this quantity of tablets? or doses? or even number of prescriptions (rhetorical but the number is not defined in guideline)
   -Dictates to doctor what quantity for therapy is appropriate
   -This quantity limitation does not figure in tolerance and/or duration of therapy. Tolerance and dose titration is subjective and must be individualized for each patient. This is restricted by guideline.
   4. The patient receiving an IRO for greater than 60 days can be offered a 14-day supply of the IRO
   -14 days?
   This was done in order to prevent pushing the patient in to withdrawal during the refusal to fill for a full valid prescription quantity. It is to be explained to the patient the reason for this limited supply offering is the guideline parameters of greater than 60 days of IRO use and that the patient must become a patient under the care of a “Certified Pain Specialist” per the guideline.
   -Problems with 14-day limitation: a. Patients right to choose doctor of choice for their care is being dictated and prohibited b. Time to appointment with a specialist if found (we can refer patient to the above allowed websites) may be greater than 14 days producing withdrawal risks c. Many pain specialists not accepting new patients. d. distance to new specialist may cause undue burden of expense and travel
   5. State database for PMP / enforces to be accessed for all hydromorphone prescriptions regardless of quantity or strength along with all oxycodone 30mg (only) prescriptions
   – no problem: done during normal due diligence reviews of patient prescription use
   6. Doctors and Patients must be within 50 miles of pharmacy in order to fill the patients’ prescriptions
   -No problem for most prescriptions / patients/ doctors; however, What of the transient vacationing visiting patient? What of the doctor from out of state for that same patient? What of the patients’ right to choose what doctor they seek care from? – If the patient relocates but chooses to maintain the doctor/patient relationship of a previous area should that valid prescription be refused? If a patient lives beyond 50 miles but chooses to travel to a local valid doctor with a valid doctor/patient relationship of their choice and to fill their valid prescription locally for convenience should that prescription be refused?
   7. Doctors prescriptions must be within scope of practice
   -Of course, No problem
   8. Comprehensive review of patient entire profile before filling to ensure appropriateness of therapy
   -No Problem, usual due diligence
   9. Verify Driver’s License
   -No Problem
   10. No discount cards or price matching
   -No Problem
   11. Document all decisions / due diligence steps on face of prescription
   -No problem

   12. Educate support staff
   -No Problem.

   All regulatory agencies have failed to intervene. The Walmart corporation was allowed to violate the law with impunity. My goal was to protect my patients and the integrity of my profession. In February 2017 I was interrogated about my activity of making reports to regulatory agencies and was terminated the same day for an unrelated policy violation. Retaliation for whistleblowing obviously the true reason. Immediately upon my leaving the remaining staff pharmacist began refusing the vast majority of chronic pain patients’ prescriptions. He was in fear for his job most certainly. The department also began the practice of subjectively blacklisting certain prescribers. One prescriber told me he received a letter from Walmart stating they would no longer accept his prescriptions.
   The pendulum has swung to far. It is now politically incorrect to defend the responsible and legitimate use of Opioids for pain. The rising tide of ill conceived policy making at all levels is harming patients.

   Reply
4. 

   Karl Deigert, on December 21, 2017 at 10:09 pm said:

   I sent along a synopsis of my story about Walmart’s use of an unlawful mandate here in a Florida.

   Reply
   • 

     criminally inpain, on December 22, 2017 at 1:01 am said:

     I too live in Fl. & was wondering what mandate walmart is using? Thanks for any info you can share.

     Reply