TOXIC… The Bottom of the Funnel Has Been Targeted By the DEA. Pain patients be damned.

Jp Enlarged

This pharmacist owner of an independent pharmacy needs your advice and assistance.  Many good heads makes for less work and more studied conclusions.   Those of you who have followed my column in Drug Topics magazine and who have spent time right here know that I have contended for a long time that we are “The bottom of the funnel”.  

What does this mean?  The pharmacy is where the rubber meets the road.  What better place to attack a rubber meeting road problem?  What better place to solve the abuse of C-II drugs than the pharmacy?  The DEA looks at how to solve their problem (And it is THEIR problem, not ours).  They determine that it is easier to go right to the bottom of the funnel and put pressure on there.  The idea of second-guessing a prescriber is much too ambiguous.  Pain therapy is subjective.  A ten for one patient is a six for another.  How can a DEA agent question a doctor?

At the pharmacy, they can count doses.  So, some bright ass mathematician at the DEA devised an algorithm that determines how many doses of Oxycodone 30 mg (and all of the others) that a pharmacy doing so and such volume should buy each month.  That is average.  But we all know that an independent pharmacy will not survive with AVERAGE.  An independent owner will have to offer exceptional services if it is to survive.  An independent who decides to serve the pain patient community has an ass that is grass, that’s how it looks. 

I can just hear the round table discussion in Attorney General Holder’s office. 

“What the hell are we going to do about the diversion of Schedule II Rx-Only drugs?”

“Let’s go after the motherfuckers who are prescribing these drugs.”  This from DEA agent who has spent too much time in the field.  An office-bound agent would no use the word “motherfucker”.  She would say “Bad actor.”

“Too tough a job.”  suggests a white guy 50-something DEA guy who is savvy about the job and about the problem.  “Let’s do it the easy way.  Let’s cut the diversionary supply where the rubber meets the road.” 

There is further discussion and the bright ass mathematician presents a 40 minute Powerpoint show about his numbers.

“Shit, motherfucker, that is too easy.  Hardy har har.  All we have to do is get our boy here’s computer to crunch the numbers and when a motherfucker buys too much, we go them.”

“What if the quantities are needed, for real pain patients?”

“Shut up, man.  We want this easy, not difficult.  We have our marching orders from Congress.  Stop the stem.  What easier, better way?”

“So, we go after the drug store industry!”

We know what happened then.  The WAG I worked in two days a week in

Galveston is 4 blocks away from all of the University of Texas Medical Branch Clinics.  I worked Tuesday mornings and Tuesday mornings was when the Schedule II orders were finalized.  In cahoots with the Senior Tech, I made sure that we were in stock.  It did not take long for the regular UTMB pain patients and the parents of ADHD patients to get the message around.  “The Walgreens on Seawall Boulevard has full stocks of everything.”  I honestly wonder if the seawall WAG is having to turn patients away.  If so, that is pathetic.  There isn’t a seeker among this diverse group, from pain clinics, to oncology, to rheumatology to…. You get the message.  Perhaps WAG just said to the Pharmacy Manager, “Sorry, but Mrs. Pancreatic Cancer Lady who is used to getting 400 Methadone 10 mg on top of  her 120 Oxy SR 80mg every month.. well tough shit.”

 After the red, the black type is from an independent owner who certainly crossed all of the tees and dotted all of the eyes.  What is your call. “Is this owner getting hosed unfairly?”   If so, what can we do about it?  This is a problem that will cause stores to close.  Pain patients will not be able to get the drugs they need.

 I say, “Go after the weasel prescribers.”

 Steve, I am interested in your view.  I know that this is close to your heart.

 Jay Pee

 Send me your name and e-mail address if you want to correspond directly with this owner.  You know, if our profession cannot handle this issue, perhaps we just need to back off and call ourselves robo-dispensers.

 

We are considering LEGAL action against our prescription drug wholesaler for BREACH OF CONTRACT … please review the Cliff Note version and R.S.V.P.

  • Wholesaler informed us of “threshold” for Oxycodone products in February
  • Oxycodone order HELD by wholesaler in March
  • Questioned, debated and argued with wholesaler about HELD order … response was “suspicious ordering”
  • Demanded an audit from Wholesaler Regulatory Affairs Department … scheduled for April 4th
  • Hired a Business/Contract Law Attorney
  • April 4th – Auditor REFUSED to perform audit with our Attorney present – our Attorney agrees to leave
  • Auditor had Law Enforcement background (NOT Pharmacy or Medicine) and was only concerned with NUMBERS of prescriptions and tablets … REFUSED to review any documentation, claiming it was a HIPPA violation.
  • April 15th call from V.P. of Franchise (essentially) asking us to dissolve the business as we had been “targeted” by DEA … we explained the “TRUE” story and V.P. said “I have some DAMAGE CONTROL to do”
  • May 1st call from Wholesaler Regulatory Affairs Department stating that ALL orders for Oxycodone 15 and 30mg are being HELD … would not say why
  • Our Attorney sends a letter meant to intimidate
  • WRDA responds that we are not following Federal and State Guidelines due to suspicious ordering
  • Attorney responds with our timeline of events which includes F&S Statues on Corresponding Liability and Pharmacist Judgment
  • WRDA responds that they are TERMINATING ALL CONTROLLED SUBSTANCE ORDERS as of June 3rd
  • Attorney threatens a Temporary Restraining Order and a Conference Call is scheduled for June 11th WITH THE CONDITIONS that WE can ask NO questions, THEIR Attorney MUST be present and we cannot Facebook, Blog or Tweet ANYTHING about the call
  • Attorney sends a multiple page document which includes our CV, Controlled Substance Protocol, Employee Drug Diversion Training Protocol and a detailed flow chart on HOW we determine whether a prescription has been written for a legitimate medical purpose (these are attached for your perusal)
  • Conference call lasts for approximately 30 minutes … the only thing they want to discuss is WHY I would fill #720 Oxycodone 30mg and #450 OxyContin 80mg to ONE client monthly … FYI – they were provided ALL documentation on this client – Ex-Police Officer SHOT multiple times in back 10 years ago.  On Workers Comp, been on SAME dose for SEVERAL YEARS, diagnosed 2 years ago with Anal Cancer and now is in Stage IV.  Patient was referred to us by a Colleague who was told by his CHAIN PHARMACY to STOP filling the prescriptions BECAUSE MD IS SUSPICIOUS
  • We were audited by Workers Comp on this client with NO ISSUES or BACKBILLING
  • We have had no correspondence from WRDA since June 11th

Question … would YOU invest up to $10,000 to fight this knowing that your entire business is at stake either way?

Remember, another wholesaler will be reluctant to sign a Controlled Substance Contract with you knowing that another wholesaler has TERMINATED shipments.

Thanks for your Professional Opinion on this matter

Mission and Vision Statement

To use a Visionary approach in dispensing prescriptions and providing medication management Services that are focused on the client achieving an optimal outcome in therapy, while extending the utmost Respect to each individual in response to their health care needs.

We will offer the residents of XXXXXX a choice, by reintroducing the traditional values of the small town main street drug store.  Focusing on the timeless and classic art of customer service, we will provide local sundries, over-the-counter and prescription drugs, and comprehensive immunization and medication therapy management programs in a personalized, community oriented atmosphere.

Demographics

* We officially opened on XX/XX/XX and we are the only locally owned and operated full-service independent retail pharmacy in XXXXXX, XX; servicing a population that is approaching XXXXXXXXXX.

* We are competing in a market of Walgreens, CVS, Supermarkets and Mass Merchants

* We grew by 180% in the first year

* We grew by 130% in the second year

Services

* We accept ALL Major Insurance and ALL State programs

* We offer REGIONAL Delivery service at NO CHARGE

* We utilize Vial, BubblePak and DispillÔ packaging at NO CHARGE

* We offer IN HOUSE charge accounts for the Public Fiduciary in THREE counties, SEVEN Private Payee Services and 30 Private Patients

Professional Clients – ALL of which utilize Controlled Substances

* University of XXXXXXX Athletics Department

* XXXXXXX Hospice

* XXXXXXBehavioral Health – Suboxone Induction Program

* XXXXXX AIDS Foundation

* XXXXXX Counseling – Federally Funded Behavioral Health Program

*XXXXXXX – Transitional Living Facility

* XXXXXXXX – Pathways out of poverty

* 55 Assisted Living Homes

* 30 Private HOMEBOUND Clients – referred to us by XXXXXXXXXXXXXXX Nursing Services

Professional Alliances

* Rotation site for the University XXXXXXXX College of Pharmacy for their IPPE & APPE programs (Introductory & Advanced Pharmacy Practice Experience)

* Collaborative Business Agreement with the XXXXXXXX AIDS Foundation and their XXXXXXXXX XXXXXXX Buyers Club – Pharmaceutical grade vitamins and nutritionals

Marketing

* Primarily WORD-OF-MOUTH

Staff

* 4 Certified Pharmacy Technicians with over 35 combined years of experience

* NO Federal or State actions against either licensee

* 4 Pharmacy Interns – one is a USA Paralympics Wheelchair Basketball Athlete

* 2 Pharmacy Technician Trainees – BOTH are Pre-Pharmacy Students

* 1 Delivery Driver

* 1 PerDiem Pharmacist

Pharmacist In Charge

* 40 years of practical retail pharmacy experience

* Bachelor of Science from XXXXXXXXXXXXXXXXXX in 1982

* Active licenses in three states

* NO Federal or State actions against any license

* Certified in Medication Therapy Management by American Pharmacists Association

* University of XXXXXX Adjunct Professor since 2011

* XXXXXXXX Pharmacy Preceptor since 2003

* Currently studying for Certification in Pain Therapy Management through University of XXXXXXXX School of Pharmacy

 

  • We verify ALL controlled substance prescriptions
    • MUST be written for a legitimate medical purpose and be therapeutically appropriate
    • The verification process may take up to 72°
    • We utilize the XXXXXXX Prescription Drug Monitoring Program for ALL NEW clients and randomly for established clients wwwXXXXXXXX.gov/CS-Rx_Monitoring/practioner_procedures.asp
    • We require diagnosis information and treatment plan faxed from the prescriber’s office for NEW chronic pain patients
    • We require a current urine drug screen (<60 days) faxed from the prescriber’s office for NEW chronic pain patients and randomly for established clients
    • We require controlled substance prescriptions to be covered by insurance
    • We DO NOT accept “Discount Cards” for prescriptions
    • We DO accept manufacturer coupons for prescriptions
    • We require established chronic pain clients to utilize our pharmacy exclusively for all medications
    • The Pharmacist on Duty will follow XXXXX § R3333333 and exercise sound professional judgment when determining whether or not to dispense a prescription, taking into consideration the unique attributes and exceptional circumstances of each client
    • Clients can be discharged for failure to follow above policies

 

– Professional Judgment Flow Chart

Client presents Rx for Controlled Substance

  1. Ask for Photo ID and Insurance
  • Yes – continue
  • No – DO NOT FILL
  1. Present Controlled Substance Policy and explain 72° wait period
  • Client approves – continue
  • Client doesn’t approve – DO NOT FILL
  1. Fax MD for diagnosis, treatment plan and urine drug screen
  • Response – continue
  • No response – DO NOT FILL
  1. Review Client history on XXXXXX Prescription Monitoring Program
  • Information consistent – continue
  • Information NOT consistent – DO NOT FILL
  1. Review therapy
  • Consistent with therapeutic guidelines – continue
  • NOT consistent with therapeutic guidelines
    • Consult with prescriber or other healthcare professional
      • Therapy appropriate – continue
      • Therapy inappropriate – DO NOT FILL

 

  • ALL information obtained MUST BE CONSISTENT WITH THERAPY for prescription to be filled.
    • We alert theXXXXXXX Board of Medicine if concerns arise with prescribers
    •  We no longer fill any NEW prescriptions for that office – established patients are monitored on a regular basis
    • We have never alerted the DEA – XXXXXXX Board of Medicine is much more responsive and they will alert the DEA if deemed necessary.
    • Decision NOT TO FILL is permanent for client
    • Client’s will be DISCHARGED for failure to follow established protocol (11)

 

 

 

 

22 Comments

22 Comments

  1. Goose  •  Jun 26, 2013 @11:16 am

    Since this story has some implications for quite a variety of people, I think we should try to get the word out to as many media networks as possible.
    I worked a shift at my friend’s independent pharmacy on Monday. I took several phone calls from MD offices asking if we were accepting any new patients who were taking pain medications. It seems they were being turned away from the chains or asked to jump through an unreasonable number of hoops to get their pain meds.
    We were not even talking about CII meds, we were talking about hydrocodone.
    Friends, if we ever needed to draw a line in the sand it is now. We cannot spend our time second-guessing and documenting everything. Professional judgement has to count for something.
    I’m contacting my reps on the state and Federal level today.

  2. Cvsconsumesyoursoul  •  Jun 26, 2013 @11:48 am

    Hydrocodone in NY is a C2. It’s only time before all states adopt that. Should we assume that the med has more addictive potential all of a sudden or is it the faulty prescribing practices of the docs who give out 240 a month and advise 2 every 4 hours? Something has to give here. My state has a provision to dispense 100 dosage units or a 30 day supply, however they clarify a dosage unit as not the tablets themselves but rather how many are taken per dose.

    I think we should just go to a federal dispensiary for all narcotics and opiates. If the Feds want this shit so bad then everything funnels through that. We all know that this has the potential to get very bad and there is nothing we can really do about the federal government. The APha surely isn’t going to do shit nor will the mockery of the supposed pharmacists who sit around a table in your state once a month or so.

  3. wellilbe  •  Jun 26, 2013 @3:24 pm

    think that’s bad now read this: http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2013/06/ama-tells-pharmacists-dont-call-us-well-call-you-.html , basically AMA saying physicians should not answer RPH questioning about validity of prescriber controlled rx’s as it interferes with the prescriber patient relationship even though the dea says its a 50/50 responsibility for preventing drug diversion. Jim we need to get the pharmacists to report every MD who refuses to give diagnosis codes and reasoning with their controlled rxs when asked.

  4. Pharmaciststeve  •  Jun 26, 2013 @7:36 pm

    If of all.. here is a website http://www.usnpl.com that lists all the TV/newspapers throughout the country – by state.. their phone number, fax number, Facebook, Twitter for each outlet.

    I think that I can speak for JP.. and I think that The Pharmacy Alliance letterhead on anything faxed out by anyone.. could bear some more weight..

    There were a couple of lawsuit in the early 90′s against a couple of docs that let some end of life pt die without any pain management.. both cases the plaintiff WON.. somewhere ONE MILLION +… they did not sue the docs on mal-practice.. but SENIOR ABUSE … but today.. cancer pts usually don’t have a problem getting pain meds.. particularly since the ONLY thing opiates are approved by the FDA is cancer pain.

    At one time the DEA published a list of drugs of concern and Morphine was NOT ON THE LIST… but Robitussin DM WAS..

    I recently posted a video on my blog where people are now “huffing” alcohol vapors.. by passes the liver and goes straight to the brain.. roughly 5% of our population will find some substance to abuse.. because they have unmet mental issues and they are trying to self medicate the “monkeys” on their back.

    I also wrote recently about Life.. Liberty.. pursuit of Happiness.. if quality of life is equal to happiness.. then the DEA .. is UNCONSTITUTIONAL… because even those who abuse the drugs.. are pursuing happiness.. at least their own version of happiness.

    Recently certain members of Congress – who are prolife – are talking about fetus “feeling pain” after so many weeks and trying to use this as justification to curtain abortions – NOT INTENDED TO OPEN A DISCUSSION ABOUT ABORTION !

    Our society frowns on us using “aggressive interrogations” techniques on those that try and kill us.. they came that torture is infliction of pain..

    One could argue that the withholding of adequate pain management is a form of torture..

    We have three wholesalers that control 80%-90% of the market and they are all PUBLIC COMPANIES .. could we get RPH’s to show up at annual stockholder meetings.. it only takes owning one stock of a company to be eligible to show up and make a statement… the wholesalers are “torturing” people in our society… send mailing to the mutual funds that are major holds of these companies…

    Those in the E-suites of these corporation are more protective of their company’s imagine and their stock price .. than their own kids..

    we have to get the people involved.. unfortunately… most of these people are up to their ear lobes dealing with their own issues..even before their pain meds have been taken away… but .. if they have a spouse.. they are probably getting real pissed..

    I know personally.. people can screw with me.. that is ok.. I am a big boy.. they start screwing with my wife, daughter, dog or MY TRUCK.. then they have over stepped their safe zone.. they are mine…

    IMO.. there are so many “tender points” to go after.. but it is not about US.. it is about those poor pts that are being denied care.. intentionally inflicted with pain.. even tortured and/or abused.. BY OUR OWN GOVERNMENT !

    I would suspect that all of these legit pts would be covered under the ADA.. and the ADA law was written very vague two decades ago.. so that the court systems could define it.. and they still are.. if you have ever seen what the fine is for the most minor violation of the ADA.. they are typically off the chart…

    IMO.. we have to organize our pts and their families.. the families are being impacted as much or more than the pt themselves.. they are probably feeling hopeless.. and getting MAD AS HELL … they have the mental/physical energy – unlike the pt – to put up a fight..

    Many of us.. have politicians as customers.. CORNER THEM… call them at home.. go to their office…

    IF I remember correctly.. it was mostly the Democrats about not torturing those that would try and kill us.. they are going to be struggling at the next election.. after people find out what a joke Obamacare is.. they will be – or should be – looking for something to demonstrate how they are looking after the “little guy” and those that are being abused by our government…

    I am always willing to talk .. you can find my email on my website..

    Remember it is NOT ABOUT US.. people could care less if this INDY loses his store.. but if one of his pts dies in agony.. they will care…

  5. Pharmaciststeve  •  Jun 26, 2013 @8:20 pm

    Second thought.. is the LTC industry having the same problem – getting supplies and being cut off .. as the community part of the Industry?

    I’m going to ask some questions tomorrow when I work at the LTCP.. It would be interesting if the 1st-2nd largest LTCP in the country .. is not having problem getting Oxy ..

    if so.. could we be talking about selective enforcement or discriminatory enforcement.. we have just seen how the IRS was selectively putting hurdles in front of “conservative” entities that was seeking non-profit status.

  6. Pharmaciststeve  •  Jun 27, 2013 @5:28 am

    After some sleep – but not much – on this issue… I think that this indy is going to not only get an attorney.. but also get – or team up with other indys & PR group… If he is a member of NCPA – contact them.. if he is not a member of NCPA – shame on him… there are some 22 K indys and most are probably in the same boat… Unless he can get a emergency injunction… IMO.. these large corporations will drag it out for years in the court… and let him run out of money and go away…

    We have already seen that the wholesalers and the chains will just cave to whatever the DEA pressure they put on them. There was just a press release from WAGS ..they are going to focus on building their FRONT END.. they are – IMO- going to turn all/most of their stores into CONVENIENT STORES.. they are going to fill Rxs for pts that have no associated risks .. whatever that risk may be.

    IMO.. in the short term.. this is going to be a RP battle… we are getting more and more entities that are basically practicing medicine without a license nor care what their – or who – they harm or kill..

    I can assure you.. that if the DEA keeps getting their way.. the suicide rate among chronic pain pts .. is going to skyrocket upward.

    but.. the DEA will not count these deaths .. as drug related… because it does not fit or will harm their agenda.

    Is this just another scandal that is showing up with our federal government on a weekly basis?… is this a precursor to Obamacare’s controls and “death panels”.. after all these people are probably part of the 20% that spend 80% of the money…

    Maybe this is what the current administration had in mind when they said that everyone insurance’s premiums was going to go down..

    IMO.. the DEA is basically telling chronic pain pts that they are just going to have to learn to “suck it up”.. maybe someone should take a baseball bat to many of these DEA agent’s patella .. and see how well they “suck it up”

  7. broncofan7  •  Jun 27, 2013 @7:55 am

    You all will LOVE THIS! here’s the AMA’s take on Pharmacist’s contacting Prescribers for information pertaining to prescriptions written for pain relieving narcotics such as DX, etc….”RESOLUTION 218
    –AMA RESPONSE TO DRUG STORE CHAIN INTRUSION INTO
    MEDICAL PRACTICE”

    Apparently, physicians are so offended that a Pharmacists dare contact them for additional information regarding narcotics that the AMA is “RESOLVED,
    That if the routine inappropriate pharmacist prescription
    diagnosis verification requirements and inquiry issues
    are not eliminated or resolved promptly quickly,our
    AMA will advocate for legislation to eliminate any such
    requirement legislative and regulatory solutions to prohibit pharmacies and pharmacists from denying
    medically necessary and legitimate therapeutic treatments to patients.”

    http://www.ama-assn.org/assets/meeting/2013a/a13-refcomm-b.pdf

    starts on page 21

  8. broncofan7  •  Jun 27, 2013 @7:59 am

    The AMA’s position DIRECTLY conflicts with the Texas State Board of Pharmacy’s laws : http://www.tsbp.state.tx.us/files_pdf/Certified_Pain_Management_Clinics.pdf

    From the Texas State board of Pharmacy website: “Pharmacists are required to assess each individual prescription and determine if it has been issued for a legitimate medical purpose. The fact that a physician who issues the prescription works in a certified pain management clinic does not automatically make the prescription valid or relieve a pharmacist of the responsibility to determine that the prescription is valid and has been issued for a legitimate medical purpose”

  9. broncofan7  •  Jun 27, 2013 @8:03 am

    http://www.ama-assn.org/assets/meeting/2013a/a13-refcomm-b.pdf

    Resolution 218 to be adopted as amended

    “Resolution 218 asks (1) that our American Medical Association deem routine calls from pharmacists to verify the rationale behind prescriptions, diagnosis and treatment plan to be an inappropriate interference with the practice of medicine and unwarranted
    (Directive to Take Action); (2) that our AMA communicate its policy in routine pharmacist prescription diagnosis verification calls with involved companies, the Federal
    Drug Enforcement Administration, and other involved state and federal regulators and
    legislators(Directive to Take Action); and (3) that if the routine pharmacist prescription diagnosis verification call issue is not eliminated quickly, our AMA will advocate for legislation to eliminate any such requirement. (Directive to Take Action)”

  10. Goose  •  Jun 27, 2013 @11:38 am

    I would remind the AMA that if they get into a pissing match with the Feds, the Feds will win.

  11. John O  •  Jun 27, 2013 @5:40 pm

    The best answer I have for pharmacies that have been limited by their wholesalers is to ask any patient for whom you are unable to fill a prescription due to the wholesalers limits, to file a complaint with the Board of Pharmacy. The Board is a patient advocate; if a patient is lawfully prescribed medication for which he/she is being refused service due to the actions of the wholesaler, the wholesaler may be in violation of a statute.
    We, in California, have identified a statute for which we believe action can be taken by the Board, if they choose. We shall see if this works.

  12. Steve Moore  •  Jun 27, 2013 @7:30 pm

    I bet the wholesaler has a lot in common with a baseball team in St. Louis. They have been doing this to independents everywhere, we can thank the pain clinics in Florida for the DEA taking the sledgehammer approach.

    We deal with an independent wholesaler and in the last few months they, per the DEA, have started questioning orders that exceed our historical usage. They call, ask their questions without accusing us of anything, and as we have scripts to match what we use, no problem.

  13. Pharmaciststeve  •  Jun 27, 2013 @8:44 pm

    @ Goose.. you are correct.. even if the AMA/docs starting withdrawing from participating in Medicare/Medicaid/Obamacare… and how would the feds react??? how about tying the renewal of your DEA license with your participation in the above mentioned programs.

    Everyone in healthcare are nothing but puppets and the Insurance companies and the bureaucrats are holding the controls…

  14. Peon  •  Jun 27, 2013 @9:46 pm

    It appears that the problems pharmacists will face with the DEA and Obamacare will be some of the biggest problems we have faced in decades. Patient care is being denied by the DEA. The real issue is not stopping drug diversion. The DEA has not stopped the influx of illegal drugs into this country and they will not stop the diversion of rx drugs. I am going to take a guess that about 7% of the population will abuse drugs or divert their drugs into an illegal market. The DEA’s response is to shut off the drug supply to the pharmacies. This means that the 93% of patients that really need pain meds will be affected by the DEA restrictions.

  15. pharmacyslave2000  •  Jun 28, 2013 @7:35 am

    I see two main reasons why this is unfolding the way it is. First, as the post from Broncofan7 would indicate, the AMA is a powerful entity that will not be intimidated. They may not win the battle, but they’ve already shown they will not go down without a fight. I think we can agree that most issues with drug diversion originate from unethical physicians. “Pain management” is a very profitable and very objective specialty that allows these doctors to operate in a “gray” area that can’t be easily controlled and provides a lot of opportunity for questionable practices. They are not going to let their business model be destroyed. There is to much at stake.
    On the other hand, pharmacy is the “98 pound weakling” of healthcare. Where is the APhA? They should have already released a rebuttal to the AMA on this issue. We are being targeted because we are the weakest. We are not only at the bottom of the funnel, we are also at the bottom of the healthcare totem pole. I blame most of this on the “fill everything that comes in the door” mentality of the corporations. They’ve brought this battle on pharmacy and we are the soldiers in it whether we like it or not.
    ***
    Unfortunately, this is just the beginning. This isn’t going away any time soon and I don’t believe we stand a chance. We were told at a corporate meeting that the DEA is targeting doctors, corporations and INDIVIDUAL PHARMACISTS. Every controlled substance filled that carries your name could be the one that gets your license revoked, or worse. Many of you question my stance on this issue and that’s fine. There is a reason I feel the way I do. My career, and yours as well, is now on the line every time that you dispense controlled substances. You better be damn sure that you’ve got your shit together and even then, as JP’s story shows, that may not be enough to save you.

  16. broncofan7  •  Jun 28, 2013 @9:09 am

    The APhA is a J-O-K-E. The NCPA is the largest organization that TRULY has the profession of Pharmacy as it’s underlying reason for existing. If you are a member of just 1 organization, I highly recommend it to the the NCPA.

    http://ncpanet.wordpress.com/2013/06/25/ncpa-weighs-in-on-amas-pharmacist-resolution/

    “The American Medical Association’s (AMA) consideration and adoption of Resolution 218 has generated an understandable backlash from many pharmacists. Possibly inspired by a provision of Walgreen’s $80 million settlement with the Drug Enforcement Administration (DEA) regarding controlled substances, resolution 218 essentially discourages pharmacists from contacting physicians with questions in response to a prescription which raises suspicion or in line pharmacists’ professional responsibilities.

    Here’s NCPA’s take, which we provided to media contacting us about this issue:

    For the benefit of patients and our health care system, it is vital that physicians and pharmacists work together in a collaborative, constructive fashion to coordinate optimal patient care on each of their distinct responsibilities. It is important today and will only become more critical as new care delivery models such as medical homes and accountable care organizations blossom.

    We acknowledge and appreciate the changes that AMA delegates made to Resolution 218 to better recognize the role and contributions of pharmacists. At the same time, NCPA opposes the resolution, which is short-sighted and takes a simplistic approach to the prescription drug abuse epidemic that is very complex and wide-ranging in nature. We support a collective approach to controlling abuse and diversion that involves everyone: patient, pharmacist, pharmacy benefit manager, wholesaler, manufacturer, and prescriber…” MORE AT LINK

  17. goose  •  Jun 28, 2013 @12:51 pm

    The DEA doesn’t want to stop drug diversion because then they would be out of a job! They just want to look like they’re doing something.
    Have you ever heard anyone say “we are winning the war on drug diversion”? Hell no! There are more drugs being diverted than ever.
    I think it’s really funny that everyone wants to close down the IRS over the recent scandals. At least they generate some income for the government, the DEA just spends money and doesn’t accomplish anything.
    They do have a lot of power though and you have to respect that. Piss ‘em off and you’ll deal with it forever.

  18. Peon  •  Jun 28, 2013 @11:08 pm

    Is pharmacy under assault? From corporations throwing older pharmacists under the bus, to the DEA imprisoning pharmacists, where will it end? Has pharmacy become a ‘hostile’ environment? And, why would anyone want to become a pharmacist?
    -
    I have been a pharmacist for 43 years, and as I look at the pharmacy landscape today, it appears ‘frightening’. Chain pharmacy has become a place where a pharmacist cannot exercise his professionalism, can no longer be the master of his job, is being nit-picked by corporate idiots that don’t understand one thing about pharmacy, is being measured daily like an animal being primed for slaughter, and his daily consultation with patients has become an exercise in trying to get patients attention away from their cellphones and trying to explain insurance to complete morons. Pharmacists don’t even have the priviledges of average workers, but must work long hours without breaks.
    -
    Is it time to think about a new career? Is it time to just say ‘the hell with pharmacy’? I have never believed in ‘going down’ without a fight. But, the forces we face are very formidable. We might could win against the corporations if we put up a good fight, but now we have the DEA. The only thing that will stop the DEA is the American people. Once all Americans realize that the DEA is blocking pain medications for dying patients, which is the equivalent of torture, there may be a call for Congress to intervene. But, this will be years in the making.
    -
    What would be enlightening to know is just how pharmacists all across the US feel about the future of pharmacy. I wish someone would do a survey. I would like to know just where I stand as compared to other pharmacists. Am I overly pessimistic? Are the people that post here on this blog indicative of the broad spectrum of pharmacists?

  19. pharmacyslave2000  •  Jun 29, 2013 @7:27 am

    I agree with you Peon and I don’t think you are being overly pessimistic at all. We have been heading down this road since the “shortage” effectively ended a few years ago. We have Obamacare around the corner and we are under the microscope of the DEA while trying to meet the expectations of our corporations. I don’t think we will bounce back. There is no strong lobby to protect us. We are the weaklings of the healthcare system and the weak are the first to go. There will always be a need for what we do but the question is, who will be willing to do it? Will you take a pay cut to work in the environment we do? Will you take on more responsibility for less pay? It will all come down to who will be willing to change with the expectations of the profession. Me, I’m always looking for a way out. I think things are going to get very unpleasant in 2014.

  20. broncofan7  •  Jun 29, 2013 @8:10 pm

    Pharmacyslave,I know that we are both in our mid 30′s. Are you licensed in Texas? If so, you should email me broncofan7@ymail.com. I’d love to sit down with you. 2014 will be a year of expansion for me as an owner.

  21. Greenhead  •  Jul 7, 2013 @1:05 pm

    Ok, so a bunch of stores got caught with their hands in the cookie jar in Florida after Florida mixed physician dispensing of C2′s. The Feds went after wholesalers supplying those who made poor choices. I’m fairly certain the DEA found problems far and wide in the wholesale industry. Knowing they could not reasonably shut done the whole system they told the wholesale industry they had to self limit their distribution. The wholesales asked what those limitations were and they were told we aren’t going to tell you, but heaven help you if you exceed it, as we will revoke many more DEA wholesale permits.

    Wholesalers run scared and look to see how to reduce C2 NUMBERS. Who to they distribute to? Hospitals, VA, PBMs, Chains, and independents. Distributors won’t reduce supply to hospitals as they are mostly good players, no reduction to the VA as that would be un-patriotic, PBMs and chains have large legal departments and would represent significant liability, leaving independently owned pharmacies as the only easy sector to reduce NUMBERS.

    The bull has been set free in the china shop.

    That said I have a lot of respect for those in the DEA who put their lives on the line every day.

  22. Pharmaciststeve  •  Jul 8, 2013 @5:26 pm

    I am sure that going after prescribers, wholesalers, and pharmacies .. is certainly high risk..

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