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.
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.
* 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
* 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
* 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
* Primarily WORD-OF-MOUTH
* 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
- Ask for Photo ID and Insurance
- Yes – continue
- No – DO NOT FILL
- Present Controlled Substance Policy and explain 72° wait period
- Client approves – continue
- Client doesn’t approve – DO NOT FILL
- Fax MD for diagnosis, treatment plan and urine drug screen
- Response – continue
- No response – DO NOT FILL
- Review Client history on XXXXXX Prescription Monitoring Program
- Information consistent – continue
- Information NOT consistent – DO NOT FILL
- 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
- Consult with prescriber or other healthcare professional
- 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)