Docs want to dispense drugs if pharmacists won't

[J Lucas]

By M. Mary Conroy

CHICAGO (Reuters Health) - The American Medical Association wants legislation that will allow physicians to dispense drugs when pharmacists say their consciences will not allow them to fill prescriptions for contraceptives, painkillers and mood stabilizers.

The AMA says conscientious objection by pharmacists is a major public health problem in many areas of the country.

To solve the problem, the AMA's policy-making House of Delegates voted Monday to ask for changes in state laws so that physicians can dispense medications when there is no "willing pharmacist within 30 miles."

Some pharmacists first balked at filling prescriptions for oral contraceptives and the emergency contraceptive pill called Plan B. But a coalition of medical specialty societies, including the American College of Physicians and the American Academy of Family Physicians (AAFP), now claims the refusals have spread to medications for mental conditions and pain medicines.

Moreover, they say that pharmacists often refuse to refer patients to other pharmacists to get prescriptions filled.

Dr. Mary Frank of Mill Valley, California, a former president of the AAFP, said some pharmacists are also refusing to return prescriptions that they refuse to fill and "they are lecturing patients. This is interfering with patient's access to care."

The new AMA policy also asked the AMA to lobby for legislation that "requires individual pharmacists or pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy."

Moreover, the AMA house directed the AMA leadership to initiate formal discussions with the American Hospital Association, the American Pharmacists Association, American Society of Health System Pharmacists, National Association of Chain Drug Stores, and National Community Pharmacists Association to guarantee that "a patient's right to obtain legal prescriptions will be protected by immediate referral to an appropriate dispensing pharmacy."

A spokesperson for the American Pharmacists Association said the organization has received no complaints about pharmacists refusing to fill prescriptions. The spokesperson added that the APhA does not have a procedure for disciplining pharmacists who refuse to refer patients to other pharmacists.



© Reuters 2005. All Rights Reserved.

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[J Lucas]

When you refuse to do your job, they will find someone else to replace you. No one or no job is secure.

 

[Caverject]

I don't have a problem with their proposal. However, I have not heard about refusal for psyc or pain meds.

 

[bananaface]

I have no problem with physicians dispensing Plan-B from their offices. In fact, it would be ideal to have it administered in the office.

The DEA isn't going to let them redesign the narc distribution system. I'm guessing the bill will dies on that basis or be revised.

 

[CircleTheDrain]

The DEA isn't going to let them redesign the narc distribution system. I'm guessing the bill will dies on that basis or be revised.

I agree! I bet instead there will be a law that pharmacists won't be allowed to refuse to fill a prescription.

 

[Caverject]

It's not a government bill. It's mearly an organization proposal that they will advocate. Obviously, they will not win the right to dispense narcotics.

 

[baggywrinkle]

I have no problem with physicians dispensing Plan-B from their offices. In fact, it would be ideal to have it administered in the office.

The DEA isn't going to let them redesign the narc distribution system. I'm guessing the bill will dies on that basis or be revised.

PLAN-B OTC!

Docs may dispense narcotics from their office if they wish, but they are then held to the same record keeping requirements as pharmacies. No conflict of interests here. I have no problem with it. They would be monitored by the pharmacy inspector just like everyone else.

I'm from the board of pharmacy and I'm here to help

p.s.
Anna, have you been to Madigan? Check them out! It is quite an operation.
I got a call from Providence in Olympia, but I think I'm going to give them a miss in favor of being a federal employee.

 

[Caverject]

PLAN-B OTC!

It wouldn't be an issue if it was! Oh well!

 

[jdpharmd?]

By M. Mary Conroy

CHICAGO (Reuters Health) - The American Medical Association wants legislation that will allow physicians to dispense drugs when pharmacists say their consciences will not allow them to fill prescriptions for contraceptives, painkillers and mood stabilizers.

The AMA says conscientious objection by pharmacists is a major public health problem in many areas of the country.

To solve the problem, the AMA's policy-making House of Delegates voted Monday to ask for changes in state laws so that physicians can dispense medications when there is no "willing pharmacist within 30 miles."

Some pharmacists first balked at filling prescriptions for oral contraceptives and the emergency contraceptive pill called Plan B. But a coalition of medical specialty societies, including the American College of Physicians and the American Academy of Family Physicians (AAFP), now claims the refusals have spread to medications for mental conditions and pain medicines.

Moreover, they say that pharmacists often refuse to refer patients to other pharmacists to get prescriptions filled.

Dr. Mary Frank of Mill Valley, California, a former president of the AAFP, said some pharmacists are also refusing to return prescriptions that they refuse to fill and "they are lecturing patients. This is interfering with patient's access to care."

The new AMA policy also asked the AMA to lobby for legislation that "requires individual pharmacists or pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy."

Moreover, the AMA house directed the AMA leadership to initiate formal discussions with the American Hospital Association, the American Pharmacists Association, American Society of Health System Pharmacists, National Association of Chain Drug Stores, and National Community Pharmacists Association to guarantee that "a patient's right to obtain legal prescriptions will be protected by immediate referral to an appropriate dispensing pharmacy."

A spokesperson for the American Pharmacists Association said the organization has received no complaints about pharmacists refusing to fill prescriptions. The spokesperson added that the APhA does not have a procedure for disciplining pharmacists who refuse to refer patients to other pharmacists.



© Reuters 2005. All Rights Reserved.

Go ahead, just make sure you follow the documentation/record keeping and counseling rules, as well as the 3rd party billing...

 

[bananaface]

PLAN-B OTC!

Docs may dispense narcotics from their office if they wish, but they are then held to the same record keeping requirements as pharmacies. No conflict of interests here. I have no problem with it. They would be monitored by the pharmacy inspector just like everyone else.

I'm from the board of pharmacy and I'm here to help

p.s.
Anna, have you been to Madigan? Check them out! It is quite an operation.
I got a call from Providence in Olympia, but I think I'm going to give them a miss in favor of being a federal employee.

I have never been to Madigan. I have, however been to the VA hospital pharmacy in Seattle and seen the robots, etc. I did my hospital competencies there one afternoon.

Providence has a huge turnover rate. Usually people there leave for TG, which is no pearl itself. The only worse hospital to work at in the area is Good Sam in Puyallup.

Are you aiming for a non-retail setting now? If you decide you like not working holidays, my company is hiring for the Tacoma area. We have plenty of tech help. Today we did 198 measly scripts and tomorrow (9-9) we have 2 pharmacists, 3 A techs, 1 B tech, and myself, all scheduled for 8 hours. The order comes in on Wed, but that only justifies an extra 4 hours on the schedule. Usually my store runs 2 pharmacists and 2.5-3 techs on a weekday. I'm finally an extra, so that I can do some intern crapola and projects. If you ever decide you are interested, my boss can probably have you in as a sub when someone is taking a day off (someone is on vacation next week but it may already be fully covered) so you could get a feel for what FM is like to work at without actually committing to anything. If you are interested, you can call my store and talk to Deneice. I'll tell her I mentioned it to you. If not, enjoy Madigan.

 

[BMBiology]

That is great news! Thank god the AMA wants to dispense!! I say the APhA should try to change state laws so pharmacists can write prescriptions for certain meds like hypertension, diabetes, etc. Lets trade places!!

 

[bananaface]

Certified Diabetes Educators or whatever can prescribe insulin and all that, can;t they? It's late. I have to find out later.

 

[baggywrinkle]

Dr. Mary Frank of Mill Valley, California, a former president of the AAFP, said some pharmacists are also refusing to return prescriptions that they refuse to fill and "they are lecturing patients. This is interfering with patient's access to care."

The new AMA policy also asked the AMA to lobby for legislation that "requires individual pharmacists or pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy."



© Reuters 2005. All Rights Reserved.

Many pharmacists, including myself, will confiscate a prescription which has been altered by the patient and refuse to fill it. This nonjudicial punishment gets the point across when you tell them that the alternative is to fill the prescription and when they try to leave have them arrested. Going to court is such a time waster, and the pharmacist gets nothing from the deal but a new enemy to watch for.

This does deny the patient access to care, but then an altered prescription is not a valid prescription.


Anna, thank you for the heads up. I got the heebie jeebies from the contact person at Providence. Anyone that signs their name Joe Blow PharmD Pharmacy Clinical Manager sounds way too puffed up for my taste. It brings sanitation engineer to mind, IMHO. I'm just an old country pharmacist. You may call me a druggist and I will not be offended, or better yet just call me Don. How may I help you today?

If I haven't learned anything else it is that ambience matters. You need to be comfortable where you work. You can size that up in about 15 minutes. You either fit in with the prevailing culture or you don't. If you don't you'd best leave because they will force you out. I like the feel at Madigan. The civilian side is very laid back in a disciplined sort of way. These folks wear jeans and sport shirts to work under their white jackets. Try and get away with THAT at Walgreens.

 

[omfsres]

news flash: physicians and dentists dispense drugs all the time, everything from HTN meds to narcotics. Its not like we want to run a pharmacy, its just convient to the patient to have the drugs in their hand when they leave the office.

 

[BMBiology]

news flash: physicians and dentists dispense drugs all the time, everything from HTN meds to narcotics. Its not like we want to run a pharmacy, its just convient to the patient to have the drugs in their hand when they leave the office.

Like free samples. It is a lot different when it involves money, insurance and liability such as the patient becoming pregnant because her antibiotic decreases the effect of her contraceptive drugs.

 

[bananaface]

news flash: physicians and dentists dispense drugs all the time, everything from HTN meds to narcotics. Its not like we want to run a pharmacy, its just convient to the patient to have the drugs in their hand when they leave the office.

In WA they can't dispense for profit, so the practice isn't widespread. I'm not sure about other states.

 

[omfsres]

Like free samples. It is a lot different when it involves money, insurance and liability such as the patient becoming pregnant because her antibiotic decreases the effect of her contraceptive drugs.

I believe in the example you give the fault would fall on the prescribing Doc before it gets to the pharmacist although there is liability for both. Ultimately all treatment errors and malpractice will fall on the physician/dentist. This is the same thing my wife used to tell me about nurses getting sued because the doc wrote a wrong order in the hospital. I'm sure it occurs on rare instances but it's certainly not the norm. Think of it another way. Compare malpractice insurance of a physcian and a pharmacist. Don't get me wrong, I'm glad there are pharmacists and they prevent a lot of errors and are an invaluable source of information especially in the hospital setting.