This show up in my inbox today?
I’ve been following your blog for awhile, as a Pharmacist, I’ve agreed with you a lot over the years, but have noticed recently that I disagree with the tone you’re taking in your posts. Recently I’ve noticed it seems you’ve moved away from advocating the pharmacist side of things, and have instead moved more towards the chronic pain patient side of things.
I understand where you are coming from…. The retail chains are running scared of the DEA and they are making and enforcing policies that are almost entirely based on CYA (Cover your Ass). I work for the 3rd largest retail pharmacy chain, luckily, so far, we haven’t been front and center in any lawsuits by the DEA, so our chain is instituting CYA procedures in filling controlled drugs; but… so far they haven’t actually stopped us from doing what is appropriate…
I have been out of school now for a few years, I was a floater for a lot of those years, and one thing you really learn as a floater is the doctors that are good vs the pill mills. The pill mills you see rxs all throughout the state; when you see the exact same oxycodone 30mg rx from the same doctor, at stores 200 miles apart, you know you can never fill for that doctor. But when you work in the same geographical area for a bit, you see the doctors you can trust, both by the patients and what they prescribe… Then…. you have the third set, where you don’t know….. You have some patients that are legitimate and others that you question….
With all that, I’ve been at the same store full time for some time now, which is a convenient commute so I know most of the doctors around. While many people abuse opiates, there are plenty of patients who are legitimate, and I never want a legitimate patient to go without. So, with my experience as a long time floater, I refuse the obvious bad rxs, but give benefit of the doubt to all the others. As such, in short period of time my pharmacy has gained a decent amount of new patients, a lot of them with various controlled drugs, and we’ve noticed our daily workload increasing… We recently our PDM started sending weekly rankings in various categories out to the district… One of those categories is script count, and since my store is not a high volume store we’ve always been towards the bottom… But, I noticed our ranking never increased as our workload increased…
I saw you mentioned a few times about controls not counting in some companies rx counts, so I’ve been meaning to check up on it. This past monday was actually slower then normal (after holiday, was crazy before hand, everyone had their drugs already), so had time to go through the daily reports and count my rxs vs. what the report from distract said. I figured out that in the random week I selected, I did about 15 -20% of scripts as controlled, and the reported weekly rx count was 17 -22% below what I counted. So, they are minusing the controlled drugs from our ratings, which counts for our staffing hours.
So, while I am filling more and more rxs, I’m not getting any extra staffing hours for it, which only increases our workload….. I have also noticed an increase in my own misfill errors in the past few months, Thank god, nothing serious, but more then I even had as a floater (in mostly well staffed stores, though could be countered by my finding my own errors vs. the minor errors other pharmacists never reported)…
So, getting back to the point, while I’ve normally filled all controlled rxs that were legitimate based on the doctors reputation and patients profile, I’ve noticed in the past couple days since I found we weren’t getting any benefit, and it was actually a drain, I’ve started wondering why I’m filling an rx; especially when there are problems on the rx which require time to fix (like writing for plain Lortab 10mg, instead of saying Lortab 10/325 or more appropriately Norco 10/325).
So there you have it.. WAGS has their “good faith policy”, It has been rumored that CVS/Caremark is doing this same thing.. and now have confirmation that Rite Aid has adopted the same policy.. before this email.. I had already heard rumors about Rite Aid doing that.. These three chains represents about 40% of all the community pharmacy outlets.. what the rest of the chains are doing.. has not come to light yet.. BUT.. someone will eventually come forward about their policies..
According to this first hand observation.. a Pharmacist trying to take care of all legit/on-time/medically necessary pts .. is putting all patients at risk for increased possibility of medication errors because the Rx dept is being increasingly understaffed.
On the other hand, this increasingly under staffing of these Rx depts.. means that any Rx that is not easily processed – for any reason – will just be turned down.. or will they just turn down controlled meds… because they are not included in what determines their staffing levels ?
Businesses have to make a profit.. but.. putting pt’s health & safety at risk and a higher priority.. is this what we expect out of our healthcare system ? The 51 Boards of
Pharmacy primary charge is the public’s health and welfare.. and these BOP’s are where on this issue ?
Filed under: General Problems
I guess we can’t be surprised when a pharmacist develops an “us vs them” mentality regarding pain patients when his company is sort of setting him up to feel that way. What I don’t get is why they use this policy…they still make money dispensing pain meds…and it seems by this post like narcotics are treated more like a loss leader. This whole mess smacks of elitism. It gives pharmacists a general sense that these patients are somehow less worthy than the rest…and if you have read any horror stories by pain mgmt patients about how they are treated by pharmacists at these big retail pharmacies, it’s easy to see that these pharmacists are clearly prejudiced. So it’s working.
Country doctors of the olden days didn’t drive Mercedes’ (or the fanciest horse carriage for that matter). Start paying doctors and pharmacists like we pay teachers. We will be left with the ones who are really in it to help and heal people.
Phil,
Thank you for the info. I’ve read a lot about (IASP) mostly information coming out of Europe on The Societal Impact of Pain and have talked with many people like Mr. Scholten by email who was with World Health Organization.
This thing about chronic pain is huge and will get straightened out some day I hope and pray. The problem is people with intractable pain need help now and its tragic to let someone suffer and go without much needed medication throwing them in to withdrawals at the same time they suffer with their chronic pain. I cant think of any worst thing other than torture itself, its similar in every aspect.
Regular people don’t understand the length and depth this thing with chronic intractable pain goes, and it gets under my skin to know older people could die of a heart attack when being refused a medication refill each month, if not grand mal seizures.
As a fellow pain warrior, I feel I could do more but when refused the filling of a in hand legit script ,this is the most difficult thing to accept and I will not accept it but it sure puts the breaks on things . Thank God for me saving some backup emergency meds.. Its hard enough finding a compassionate doctor willing to write the script then we cant get the script filled and the looks of the person on the other side of the counter at me ,like I’m a no good junkie, this is ridiculous.
It brings me and my strength to move forward to help others even more and I’ve done this for years now . Now I advocate for any and all that suffer from chronic pain to get the help they need, whatever it takes.
Thank you for your time and links.
Phil Noir ,
For the past 20 years I’ve picked up a long acting opioid every month for the chronic pain I suffer from. Just one script for chronic pain no break through medication . 3 months ago here in Houston no pharmacist would take my script and fill it or give me a reason as to why they cant fill it. So yes it is a conflict between me and the pharmacist. I deserve a reason as to why they cant fill this script and they all lie to me when I demand a answer just to get rid of me.
The pharmacy I’ve used for years said they don’t know if they will get what they order that its hit or miss, I just don’t believe this. I know a pharmacy may be limited to what they can order and if that’s the case then take my script ,order the medication and fill it, put pharamcist pick and choose who they fill for like they know who really sufferers and who don’t. My Pain doc. is in the same building as the pharmacy I normally use. Here lately I’ve been doing the “Pharmacy Crawl” and I’m sick of it.
Can you suggest any answer as to why this is happening, is the DEA limiting what you can order on opiate medications. Are pharmacist just scared they will lose their job if filling a opioid script. I cant keep going to 10 different pharmacies each month. This is beyond belief and all chronic pain sufferers are sick of it.
Dear Friend,
I’m very sorry, but I don’t know what’s happening in Texas or why you cannot fill your Rx.
Here in Colorado, we experienced a shortage of many opioid analgesics in the period of the late 2012 – early 2013. It lasted only a few months, but was an inconvenience at worst for me.
My advice is to develop a relationship with an independent pharmacist and ask them these questions.
You have a right to pain relieving medical care. There’s probably a statute written in the laws of your state, either as a patients bill or rights, or a general statement declaring pain as a 6th vital sign.
In the last decade, this kind of legislation was passed in 39 of the 50 states.
In September of 2010, at the 13th World Congress on Pain, the International Association for the Study of Pain (IASP) released a document known as the Declaration of Montreal to highlight serious deficits in education about pain, inadequacies in its treatment, the need to understand chronic pain as a disease and not simply a symptom of disease, and the appalling lack of public policy that affects an estimated 1.5 to 3 billion people worldwide.
Chronic pain is the largest epidemic on the planet today, and astonishingly, gets attention only as a side-bar in reporting morbidity related to the misuse of opioid pain medications.
Read the Declaration — it’s short and to the point, and can be found on the IASP website at:
http://www.iasp-pain.org/Advocacy/Content.aspx?ItemNumber=1821&navItemNumber=582
Please allow me encourage you to persevere, Paincare2014. As a fellow pain warrior, your voice is needed to help change public opinion in favor of compassionate treatment of for all who suffer from chronic intractable pain.
Why does this pharmacist (and so many others) divide the world between “us pharmacists” and “those chronic pain patients”?
This is a battle about serving the needy, and not about whose side you’re on.
Steve, again, thank you for the information and service you provide to all human beings, whether we be pharmacists, live with chronic pain, or are simply interested in equitable access to health care.
I think that this particular Pharmacist is “conflicted”.. the chain that he/she works for.. is “telling him/her” that if you take on too many pts using controls ..we are not going to provide you with adequate tech man hours to safely do your job.. IMO.. it would appear the job that this Pharmacist wants to do and the job that his company wants done.. are not in sync and more in conflict.
boilerrph87 ,
Gee thanks for your kindness, I could use someone that thinks positive and is a caretaker, pharmacist at this time in my life.. This is the first time I used this pharmacy because I grocery shop there and their TV commercial sais we will fill your script while you grocery shop. By the look on his face today he seemed honest by facial expressions that my script will be filled by noon tomorrow, Thursday that is July 10 of 2014.
Thanks’ for being kind to me,,,,,paincare2014.
@PainCare2014…Seriously??…He’s NEVER filled for a long acting pain med??? Did he just get off the boat??? I would expect that from someone who has never filled an IV chemotherapy order, but never, ever an oral medication of ANY kind. As someone with 27 yrs experience behind the counter, this whole treatment towards chronic pain patients is despicable. If you don’t get it tomorrow, he’s stringing you along. I know to some people I may come across as a B****, but both my husband and youngest son have mental health issues. Being an RPh has been helpful for me to work a difficult system and yet I’m also a caregiver so I have to be very pushy to advocate for them to get them the care and medications they need and deserve. Good luck!!
Yes I find it’s a very good idea these crazy days to have back ups!!!
It just aint fair putting aside legit chronic pain sufferers and treating them like they don’t mean anything to anyone. I’m still waiting on my script from July 3 rd to be filled, here it is the 9 th of July. I talked to the pharmacist today as I went grocery shopping and asked if my script was ready but he said one more day and It will be ready for you. Its like he is testing me for my patients, but I calmly said okay that will be fine as long as I get it by tomorrow afternoon. He asked where do I normally get it filled and I told him. I will be patient for one more day longer than he said it would take. He has never filled this script of a long acting pain med, So hopefully he is not messing around with me. This makes me want to just titrate off of everything but I cant give up that easy. Test me but don’t lie to me, keeping me on the hook for 3 more days than normally told. I’m no fool ,I keep a back up for times like these. Back up saved me during the last hurricane we had 6 years ago.