I received this from my Part D provider – as part of larger mailing. Notice the first paragraph and YOUR FEDERAL CIVIL RIGHTS when it comes to prescriptions filled under the Medicare Part D program as well as Medicaid. While I am not an attorney, these same rights should apply to all services provided to Medicare/Medicaid folks and billed to those two entities.
If a pharmacist refuses to fill a prescription… then the pharmacist must have FACTS that the person presenting the prescription is trying to obtain a controlled substance for non-valid medical needs – which is illegal. So a pharmacist that just refused to fill the prescription and returns it to the patient… is possibly violating the Controlled Substance Act (CSA) for not confiscating the illegal prescription and/or not calling the police and having the person arrested for trying to fill a controlled substance prescription for a non-valid medical need. Floating around in this area is probably unprofessional conduct… which is a violation of the state’s pharmacy practice act.
If the Pharmacist returns the prescription to the person and that person is able to get a pharmacist at another store.. then we face the situation that one pharmacist either filled a “bad prescription” or one pharmacist discriminated against the pt for refusing to fill a prescription. Recently, I have seen where pts are stating that Pharmacist have moved from the excuse of “I’m not comfortable” to “I don’t have inventory”… all pharmacies are required by Federal/State law to maintain a perpetual inventory on all C-II’s.. It should be able to determine what inventory was on hand for a particular C-II on any date/time. Many pharmacies – mostly independents – can get a C-II order from the wholesaler 5 days a week and many chains only get C-II orders weekly. I know that the Indiana Pharmacy Practice act has a mandate that pharmacy are required to stock medications “commonly used in the store’s market place”…
Would the board of pharmacy investigate a complaint from a pt that a pharmacy is violating that part of the practice act… “I’m out of stock” on a routine basis.. I don’t know… IF a pt could get them to investigate if inventory on hand on a particular day/time that the pt was denied having a prescription filled… then by violating the state’s pharmacy practice act.. would be a step forward in proving that the pt was discriminated against because of the medication that they need to treat their handicap.
What if a pt goes to a pharmacy and hands over a handful of prescriptions and the pharmacy is glad to fill all the non-controlled Rxs but “conveniently” “out of stock ” of any controls the pts needs. A pharmacy is never going to have on hand medications for a prescriptions presented 100% of the time, but most pharmacies can get non C-II’s within a couple of days at most.
This civil rights issue.. could it be used to challenge the formulary of the part D provider… especially when they stop covering a particular class of medication and/or apply quantity limits on a particular class of medication and/or medications that treat a particular category of disease states ( ie pain management)
In this letter it directs the pt to file a grievance with the part D provider.. is that like filing a complaint/grievance with the fox because all the chicken in the hen house are dead ? There is a complaint process at the Federal level for Medicare/Medicaid by calling 800-MEDICARE or www.cms.gov
Filed under: General Problems
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