Pharmacists Refusing to Fill Prescriptions for Pain Relievers
In the wake of a recent $500,000 fine, Walgreens has adopted a new "good faith dispensing" policy that allows a pharmacist to refuse to dispense pain relievers if the pharmacist feels that the prescription is for an illegitimate medical purpose. In a letter issued to prescribing physicians, Walgreens stated:
According to 21 C.F.R. 1306.04, pharmacists are required to ensure that prescriptions for controlled substances are issued for a legitimate medical purpose. The regulation states, in pertinent part, the following:
"The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances. "
So how does the pharmacist decide whether or not a prescription is for a legitimate purpose or not? After profiling certain doctors, patients and prescriptions, pharmacists are then asking doctors to verify the diagnosis, the previous medications tried, the treatment plan and the anticipated duration of treatment. Some are even asking questions about the doctor’s background. And Walgreen pharmacists are not the only ones starting to ask a whole bunch of questions; Costco has also adopted a similar policy.
If a pharmacist believes that the prescription for a controlled substance is issued for an illegitimate reason based on the answers to their questions, the pharmacist will refuse to dispense the medications. Although pharmacists are not supposed to deny prescriptions based on quantity alone, that is not necessarily the case. And yes, pharmacists do have a right to this HIPPA protected health information in case you are wondering.
Not only are doctors and patients upset by these sweeping changes, pharmacists are upset too. They are put into the difficult position of arguing with doctors using vague guidelines and exerting broad authority over the wellbeing of a person in pain. Many pharmacists don’t even know how to handle particular situations, but do know that the DEA is now breathing down the necks of the pharmacies nationwide, as seen with that recent $500,000 fine.
For anyone in California having trouble getting prescriptions filled, please contact the California Medical Associations (CMA) legal affairs department at: firstname.lastname@example.org. For those in other states, please contact your state’s Medical Association office.
And you can read the CMA’s statement about this new policy at:
Read the recent United States vs Walgreen settlement at:
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.