The “excuse” … “I’m not comfortable” infers that the Pharmacist has made a decision… based on certain FACTS that would make the prescription not medically appropriate for a particular pt. Level one interaction with the pt’s other medications, allergy, dose too high or too low.. having checked a PMP report the pt appears to be a doc/pharmacy shopper…
The “excuse” ….”I don’t have inventory” .. is a fact that supposedly doesn’t have anything associated with a professional medical decision. I suspect that most pharmacists believe that in saying that.. there is no way for the pt to prove that the pharmacy has – or has not – any inventory.
I was at a meeting of the FL board of Pharmacy in June of 2015 when they were discussing a new regulation about how Pharmacists in FL are suppose to NOT start looking for reason to refuse to fill a controlled prescription. It went into effect the end of Dec 2015. At that meeting a chronic pain doctor asked the attorney for the board if a pharmacist lying to a pt about having inventory was UNPROFESSIONAL CONDUCT…. and basically the response from the Board’s attorney was “.. there is nothing in the practice act that addresses that … so NO …”
After all the DEA cut opiate production quotas by up to 25% in 2017 and proposed another 20% cut in 2018. The largest pharmacy wholesaler ( McKesson) had the DEA try to build a case against them for not properly controlling the distribution of opiates and prepared to hit them with a ONE BILLION DOLLAR FINE… but apparently McKesson hired the baddest ass attorney firm in the country and the DEA attorneys became unsure of their “slap dunk case” against McKesson and every settle with McKesson paying a few million in fines.. But there were two other major pharmacy wholesalers which the DEA was probably going after next after they “took down Mc Kesson”… remember the DEA’s budget is TWO BILLION… so a BILLION more from McKesson would have allowed them to do what ?
So, I would expect that the pharmacy wholesalers are going to “tighten down” on what they will allow any particular pharmacy to purchase.
So what is a pt to do?… get use to the “pharmacy crawl” ?
Most pt don’t know that each pharmacy is required to keep a PERPETUAL INVENTORY on all C-II… They should be able to go to their perpetual inventory book and know exactly what is on hand at any moment. Each prescription filled is entered into this record by date and maybe by the time the label of the prescription was printed… also they have to enter into this perpetual inventory any increase in inventory when they receive it from their supplier.
The pt should at the very least have someone go with them to witness that the reason that your prescription was not filled was because it was stated that they had no inventory… at least take a picture of the Rx dept staff that told you “NO INVENTORY” or if legal.. video the transaction.
The only option that the pt has at this point is to hire an attorney to ask the courts to subpoena the pharmacy’s inventory records for the particular day and the particular medication to validate that there was no inventory on hand… when you presented a prescription to be filled.
Proving that there was medication on hand… and chronic pain pt or any pt suffering from a subjective disease should be considered disabled and discriminating against a person covered by the Americans with Disability Act and/or Civil Rights Act… that discrimination is considered a CIVIL RIGHTS VIOLATION.
Once a pt has proven that they have been lied to and discriminated against… the Pharmacist and maybe their employer no longer has the UPPER HAND !
Filed under: General Problems
[…] Refusal to fill: is “I’m not comfortable” being replaced with “I don’t have stock” ? […]
So Florida now has administrative rule 64B16-27.831 Standards of Practice for the Filling of Controlled Substances. It requires a Pharmacist to proactively takes steps to validate a RX before refusing with the intent being to remove subjective determinations for refusal. It’s a rule, not a law, so violations do not result substantial penalties; however, anytime a patient feels they are being mistreated they should report both the Pharmacy and Pharmacist. If enough reports are received maybe a law will be enacted to protect the patients.
Distributors in Florida use an “OMP” threshold. In 2015 that threshold was 5000 tablets and if a Pharmacy exceeded that arbitrary number shipments were stopped and Patients could not access their medications. Do the math. 5000/Avg. RX qty = less than 2Rxs/day for any given Opioid RX. Hardly a pill mill operation. So many complaints were received that in December 2015, the same time the above rule was enacted, the OMP was raised to 7500. This can be verified in Fl. BoRx published agenda on their website. Again, hardly a pill mill quantity at less than 3Rx/day. If a Pharmacy is located near several Fl. Registered Pain Management Clinics, requires by Fl. Law, and that Pharmacy has a responsible and compassionate Pharmacist, the OMP threshold can be reached quickly. When the OMP is reached Red Flags fly and the scrutiny begins.
This is why most Big Box Pharmacy Managers simply choose NOT to carry adequate inventory which results in the funneling of RXs to a Pharmacy that does complicating the whole OMP scenario of oversight. Corporate Big Box does not mandate that any individual Pharmacy Manager maintain a certain level of inventory leaving it to the manager to subjectively determine what is kept on hand. Crazy; but, Big Box doesn’t care because they want to avoid scrutiny anyway. So many RPh are probably telling the truth when they say they don’t stock as that is the easiest way to avoid the DEA.
In my own personal case, I reached the OMP threshold of 5000 in late 2015, couldn’t get hydromorphone of any Mg for about 6 weeks and patients had to start the crawl. In 2016, at 7500, I never discovered if I would reach the threshold. Walmart, now notified that the 5000 limit has been reached, felt the need in January 2016, at my singular location, to implement an unlawful 14 point mandate that usurps Pharmacists’ professional judgement (an act unlawful in Fl by Any entity) and coerced the refusal of valid pain Prescriptions. With these coerced refusals, the Pharmacists was denying care to medicaid, medicare and disabled patients violating their Guaranteed Right to “Free Choice” of their healthcare providers.
My complaints to State and Federal regulatory agencies fell on deaf ears. The corporation was/ is allowed to act with impunity denying access to medications pursuant to validated RXs (by law above) and endangering public safety.
What a Pharmacist at Big Box says we don’t have it. You can probably believe it.
Steve- please turn on notifications for this post. Thank you.
Great idea Steve but how many of us could afford an attorney IF we could find one to take the case?
If a pt can get an attorney to understand that you are just one of probably MANY who they are doing it to others in their other stores.. once verified… they can go after the larger numbers… most attorneys are looking for LARGE NUMBER OF PEOPLE BEING HARMED from entities having deep pockets