Hi Steve, I just read an article you wrote that gave me some hope. I don’t know where to begin, so I will try to make this as short as possible. I have been on opioids for a year( on ssdi for 6 ). Not that it matters but 17 knee surgeries. Torn rotator cuff etc.. I have a perfect cures record, same dr, same pharmacist etc.. due to the opioid crisis I started hating going to the pharmacy because you had to call in, ask for the medication, feel like a criminal etc…I decided to just go through my insurance mail order. First time I did it they denied me because it was through a “regular” dr. So, they spoke with him and adjusted the amount and said I needed to see a pain management dr. So, $400 later, I did exactly as they asked. BEFORE I sent in the prescription. I called to make sure everything ok. They asked for the pain management doctors DEA number, number of pills prescribed etc..They said everything was fine and I complied with their rules and regulations. Now they said they will not fill it again. I give up! I just got my teaching credential and was getting my knees done etc..but lo and behold I was offered a job immediately so I will wait till the summer. Don’t laugh, but I am a physical education teacher! I do not know what to do anymore. Oh, also the time they sent the last prescription, they sent it 3 weeks early and I called them begging them to let me return it so it would not ruin my cures report. They wouldn’t let me and I asked if they would write a letter saying they made the mistake. Needless to say they were of no help. I believe this is a violation of my civil right? Please help, I do not know what else to do. It is Express Scripts and I have spoke. With 12 different people and they cannot seem to tell me why because they say I am within their regulations. I can be reached at xxxxx@aol.com. Sorry for any typos,I have been grading papers all day!
This is just another good example why people should not deal with mail order… they could be hundreds or thousands of miles from you and you may not even know their name… all you know is the name that they may give you. They told their person what to do to get her prescriptions filled and then refused to fill her prescriptions.
They are able to “dodge” the fact that they are attempting to practice medicine by conning or persuading the pt’s prescriber to change the quantity… that way the licensed professional of the pt changed the prescription.
If prescribers would “stick to their guns” and not agree to change the prescription, then if the person on the other end of the phone call will either have to give in to what was written, change the quantity or refuse to fill the prescription. The latter two choices is either practicing medicine without a license or denial of care.
IF you have health insurance, that policy is a contract.. and they probably have published list of their providers on .. if they are only willing to collect premiums and not provide the services promised in the contract.. then some would consider that as FRAUD.
Filed under: General Problems
If refusing to fill the script is denial of care how do retail pharmacies get away with it over and over again? From what I have heard CVS and Walgreens both do it all the time.
Because no one in authority to protect pts .. DON’T CARE… and it is claimed that 90% of the chronic pain families are struggling financially… and our legal system puts the “value of life” on a person who is handicapped/disabled, unemployed, elderly, retired.. to be about the same as the family pet – ZERO .. so there is no financial upside for a law firm to take on a case on a contingency basis. The young pharmacists especially are up to their gills in debt and they don’t carry professional liability insurance.. and their employer has no liability.. a pharmacist is a “learned healthcare professional” and their employer can’t legally tell them to fill or not fill a prescription.. but .. we have a significant – and growing – pharmacist surplus .. so if the chains were unhappy about a pharmacist denying pts their medications.. they could replace them in a heart beat.. but they are not.. what does that tell you ? the Boards of Pharmacy are stacked with non-practicing corporate pharmacists.. they are not going to do anything that is going to piss their chain employer off… in 2016 the KY BOP.. had 15 filed complaints for denial of care and they DISMISSED 14 of them with no further action.
Your so right Steve but getting an attorney to take the case is a futile effort!
What is a cures report? Thanks in advance for your time/reply! Appreciate it
Each state – except Missouri – has a prescription database where every time a pharmacy fills a controlled prescription they send the data to the particular state’s database… each calls their database a different name… In Indiana it is called INSPECT… in KY it is called KASPER … in FL it is called E-FORCSE … in California it is called CURES. In 2005 Congress passed a law to create a national prescription database NASPER http://www.nasper.org/database.htm .. signed into law by Bush (43).. but Congress never provided funding… there was an attempt to fund it in 2016.. but that failed.