Is the D.E.A. Abusing its Power against Pharmacy?

[PharmacyPodcast]

What's you opinion with the latest $80M dollar fine on Walgreens? Is the Drug Enforcement Agency a profit center for the Justice Department?

Drug Enforcement Agency Attack on Pharmacy:
Pharmacy Podcast Interview with Terry Forshee RPh., on DEA

During a strange time in our country’s history, with many of our government agencies under tremendous scrutiny based on events of misuse in power for reasons the public is fully unaware, we look to another government agency with much concern. The Drug Enforcement Agency – is part of the United States Department of Justice and their operating practices effecting the community pharmacy industry seem anything but “just”.

Blog – by Terry Forshee RPh., regarding the recent D.E.A. activity against Pharmacy

Letter to the Editor of USA Today

As a practicing community pharmacist I read with interest the story on the fine agreed to by Walgreen’s Pharmacies. Since they agreed to the fine I assume that Walgreen’s agrees that they had a lack of control and has now taken steps to correct this oversight.

My concern is how the DEA spokesperson is so quick to point the finger at pharmacist’s oversight, wholesaler’s oversight but never seem to accept responsibility for the ultimate source of this problem. After all, which government agency licenses practitioners and enables them to prescribe these drugs in egregious quantities? Exactly the DEA! Who licenses the clinics that open? Exactly, the DEA! Who solicits from ALL of the major Pharmacy Benefits Managers dispensing data that shows who is writing these prescriptions? Exactly, the DEA!

My point is, why don’t they act on the entity that INITIATES the prescriptions? Because they are infringing on a physician’s decision making and that scares them to death! They are not physicians! By the time they get around to the obvious, thousands if not millions of prescriptions have been written.

Original Blog Post – > HERE

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[pharmd201389]

No, they are not. Listen, pharmacies are where opioids are kept. We have the final day as to who gets what. We are also protected by law and our chains (I've been told this by CVS themselves) that it I don't feel comfortable doing a c2, that I shouldn't do it.

There are stupid pharmacists out there who will dispense morphine ER 15 mg #240 1 tabs every 3 hours scripts. That prescription SCREAMS fake. Only in a couple of instances would it not be, but anyway, a simple phone call to the MD to verify it, getting the DX code would avert RX abuse.

 

[npage148]

When you have lazy/crooked/naive pharmacists dispensing anything that crosses they bench we deserve scrutiny from the dea

 

[MatCauthon]

Here is repost I made from the other thread. The DEA has cracked down on my pharmacy chain as well. I have a feeling Rite-Aid, CVS and the other big players may get audits from the DEA in the near-future as well.

Everything has changed in the last month as to how we dispense hydrocodone and CIIs. We have a very specific policy, which I am not allowed to disclose, that mentions quantity limits, allowed dosing frequencies, allowable combinations of controlled drugs and other information. If prescriptions exceed these limits we have to contact the doctor's office and fill out a very detailed question sheet. If doctors refuse to comply, then we cannot fill the scripts. Our policy also wants specific diagnosis codes on these medications and we have been told not to dispense without the codes.

We are also using the prescription drug monitoring website much more frequently. Before, most of our pharmacists didn't even have a password to that database yet. Now it is required. I am surprised many of the other chains have not yet implemented these changes, but it is only a matter of time before it happens. Walgreens was just the beginning.

All of these changes are taking a major toll on our workflow, however. Things have been backing up in a major way since we implemented the changes. They are adding at least 1-2 hours of work each day to our load.

 

[Travex]

No, they are not. Listen, pharmacies are where opioids are kept. We have the final day as to who gets what. We are also protected by law and our chains (I've been told this by CVS themselves) that it I don't feel comfortable doing a c2, that I shouldn't do it.

There are stupid pharmacists out there who will dispense morphine ER 15 mg #240 1 tabs every 3 hours scripts. That prescription SCREAMS fake. Only in a couple of instances would it not be, but anyway, a simple phone call to the MD to verify it, getting the DX code would avert RX abuse.

Have you called to verify a script from FL yet? If it's from a "pain clinic" then a phone call makes no difference. You can tell them the pt name/DOB and they will read you the script/dx code and whatever else you want. You can't avert anything because as far as you can tell everything about the Rx is legit. It's not like you can diagnose the patient and make sure the use is appropriate. If the DEA wants to change anything then they need to shut down these "pain clinics" and take away some MD licenses. I agree that there are instances where the pharmacist can stop the obvious ones, but that is not always the case.

 

[pharmd201389]

Have you called to verify a script from FL yet? If it's from a "pain clinic" then a phone call makes no difference. You can tell them the pt name/DOB and they will read you the script/dx code and whatever else you want. You can't avert anything because as far as you can tell everything about the Rx is legit. It's not like you can diagnose the patient and make sure the use is appropriate. If the DEA wants to change anything then they need to shut down these "pain clinics" and take away some MD licenses. I agree that there are instances where the pharmacist can stop the obvious ones, but that is not always the case.

Then just fill it. What's the problem? Again, as long as its not something insane such as morphine #240, ill fill it. I wouldn't even call.

And, Likewise, if its something asinine like perc 10/325 #180, I won't fill it. I wouldn't even call the prescriber. I just say I don't have it right now and it takes 7 business days to order a quantity as large as that because it has to be verified by the dea.

Once you say that, the junkie will grab the script and run out the door.

 

[MindOverMatter]

Then just fill it. What's the problem? Again, as long as its not something insane such as morphine #240, ill fill it. I wouldn't even call.

And, Likewise, if its something asinine like perc 10/325 #180, I won't fill it. I wouldn't even call the prescriber. I just say I don't have it right now and it takes 7 business days to order a quantity as large as that because it has to be verified by the dea.

Once you say that, the junkie will grab the script and run out the door.

I wish it were that easy here. I see morphine IR #240 and Percocet 10/325 #180 at least 30 times a day. They are all "valid" prescriptions in the sense that the patient didn't write them on a stolen pad. You can call and the MD will "verify" that it is legit, and he will give you dx codes, etc. It doesn't matter. They are scandalous. They know it, the DEA knows it, and the patient knows it. And if you say it takes a week or more for the DEA to verify it, they will say "that's fine, I'll leave my script here".

At the end of the day, the onus is on you determine the appropriateness of the prescription. I probably deny more prescriptions that I should, simply because of the doctor, the type of med that is prescribed, or the patient not having a filling history with us. But I've been burned before, and I don't want to jeopardize my license for someone else's addiction.

 

[PharmacyPodcast]

Pharmd201389

I disagree with you. The D.E.A. is out of line. Rather than investigate the prescribers and upset the American Medical Association lobbing group - pharmacy is being targeted. The MAJORITY of pharmacies - especially those who own their pharmacy businesses are not abusing their trade. The Justice Department is targeting wholesalers and pharmacies to make a buck. This IS NOT about solving the problem - and if it was - the D.E.A. would "work with pharmacy" not against pharmacy within investigations to rid their communities of "pain clinic" prescription shops.

 

[npage148]

Pharmd201389

I disagree with you. The D.E.A. is out of line. Rather than investigate the prescribers and upset the American Medical Association lobbing group - pharmacy is being targeted. The MAJORITY of pharmacies - especially those who own their pharmacy businesses are not abusing their trade. The Justice Department is targeting wholesalers and pharmacies to make a buck. This IS NOT about solving the problem - and if it was - the D.E.A. would "work with pharmacy" not against pharmacy within investigations to rid their communities of "pain clinic" prescription shops.

They will work with the pharmacies when they show some discretion filling ridiculous C2 scripts. I could call my local DEA guy and say, "Hey I think Dr. XXX is pill-milling, maybe it should be looked into" and they would be like "cool, thanks." It's easy to target pharmacies (with all their records) when you have stores filling anything that enters the door.

It's like being mad that you got pulled over for running a stop sign in front of the police office. Why not go after the easy stupid ones?

It's not hard to look at a script/patient to tell if it's even remotely legit and just tell them you won't fill it becasue you feel it's not a legit script. The DEA will back you up and so will/should your higher ups

 

[PharmacyPodcast]

They will work with the pharmacies when they show some discretion filling ridiculous C2 scripts. I could call my local DEA guy and say, "Hey I think Dr. XXX is pill-milling, maybe it should be looked into" and they would be like "cool, thanks." It's easy to target pharmacies (with all their records) when you have stores filling anything that enters the door.

It's like being mad that you got pulled over for running a stop sign in front of the police office. Why not go after the easy stupid ones?

It's not hard to look at a script/patient to tell if it's even remotely legit and just tell them you won't fill it becasue you feel it's not a legit script. The DEA will back you up and so will/should your higher ups

The pharmacy owners over the past 3 years - who have shared with me about their trials with the DEA and the wholesalers who are ULTRA sensitive about servicing these community pharmacies - are legit. Did you even listen to Terry's interview?? This is a champion of Pharmacy, of healthcare, and of his community - and NO THE DEA IS NOT WORKING WITH HIM!!! He has dozens of times called the DEA to collaborate. Professional discretion? ARE YOU kidding me? These are business owners - and the pharmacy profession is their livelihood. I've witnessed over 30 owners being harassed in the last 18 months and 1 out of 30 wasn't documenting correctly and got shut down. 1 out of 30.

 

[pezdispenser]

They HAVE been cracking down on doctors. Just search the news for all the pill mill docs who have been thrown in jail. They also send 'mystery shopper' patients into doctors' offices to see if they are following Board of Medicine protocols for pain management. There is a blacklist of a lot of doctors who were caught for being too loose with narcotics, but I am not allowed to release it.

So the DEA is not just targeting pharmacists. They really are cracking down on EVERYONE with a DEA license. Even wholesalers like Cardinal, who are probably complaining more than pharmacists because they have less knowledge of the drug trafficking problem.

 

[crossurfingers]

Have you called to verify a script from FL yet? If it's from a "pain clinic" then a phone call makes no difference. You can tell them the pt name/DOB and they will read you the script/dx code and whatever else you want. You can't avert anything because as far as you can tell everything about the Rx is legit. It's not like you can diagnose the patient and make sure the use is appropriate. If the DEA wants to change anything then they need to shut down these "pain clinics" and take away some MD licenses. I agree that there are instances where the pharmacist can stop the obvious ones, but that is not always the case.

Just curious as to how you guys in Florida handle this. If you get all the extra info we are supposed to get while investigating but still have a suspicion about its' legitimacy (but no hard proof), do you just fill it? And if you deny it, what reason do you give the patient? Are you ever afraid of getting reported to the pharmacy board for rejecting a "legitimate" prescription?

 

[kvl1027]

The pharmacy owners over the past 3 years - who have shared with me about their trials with the DEA and the wholesalers who are ULTRA sensitive about servicing these community pharmacies - are legit. Did you even listen to Terry's interview?? This is a champion of Pharmacy, of healthcare, and of his community - and NO THE DEA IS NOT WORKING WITH HIM!!! He has dozens of times called the DEA to collaborate. Professional discretion? ARE YOU kidding me? These are business owners - and the pharmacy profession is their livelihood. I've witnessed over 30 owners being harassed in the last 18 months and 1 out of 30 wasn't documenting correctly and got shut down. 1 out of 30.

^^This^^

I work for an Independent and I will soon have my own store. I have heard horror stories from other independent owners who have become suspicious about a particular Dr's practice and then phoned the DEA to call them out. Next thing you know, the DEA is in their pharmacy auditing them!!!!! Even if you are the Straightest edge pharmacist there is, if the DEA audits you, they WILL find something wrong.
There are definitely pharmacies that need to be targeted by the DEA, but a lot of the liability lies with the physicians writing the Rx. If physicians had never become so aggressive with pain management we would not even be having this discussion.

 

[kvl1027]

Just curious as to how you guys in Florida handle this. If you get all the extra info we are supposed to get while investigating but still have a suspicion about its' legitimacy (but no hard proof), do you just fill it? And if you deny it, what reason do you give the patient? Are you ever afraid of getting reported to the pharmacy board for rejecting a "legitimate" prescription?

For me, I have no fear of being reported to the board for not filling a legitimate Rx. If there is "any doubt" at all you have the right to refuse to fill the Rx. Technically, you have the right to refuse to fill any Rx, regardless of whether or not it is a control.

At my store we just established a strict written policy outlining what Rxs we will and what we do not. If we decide we are not going to fill an Rx, I just tell them that my policy prevents me from filling it because of XYZ. I dont get into allow myself to get into any arguments about it, I just say I can't.

The only time I tell them I dont have it is when I actually dont have it. We don't give any information about C-IIs over the phone. If someone wants to know if we have something they have to come in to find out. I dont need to tell someone I have Oxy 30s so they can come in at the end of the day and shove a gun in my face.

For a while we were very very strict with regards to early fills on any controls. It was really inconvenient for our regular customers for a couple of months, but it go rid of a lot of the riff raff. We basically would not fill a new rx until it was exactly 30 days. The pt would have to completely exhaust their previous Rx before we would fill the new one or even refill Schedule 3-5s.

 

[Angela1234]

I've heard of quite a few pharmacies in other states using 30 days to get a refill, and I agree with it. Instead of telling them their oxycodone is so large it can be ordered in a week, I tell them that it is on back order and may not be in for months. We cannot keep the prescription, so you can have it back. I've had to reject more than I fill because most of them are too early to fill.

 

[owlegrad]

I've heard of quite a few pharmacies in other states using 30 days to get a refill, and I agree with it. Instead of telling them their oxycodone is so large it can be ordered in a week, I tell them that it is on back order and may not be in for months. We cannot keep the prescription, so you can have it back. I've had to reject more than I fill because most of them are too early to fill.

Statements like these make me sad. Giving tips on how to lie more effectively? Classy.

 

[wucool33]

Statements like these make me sad. Giving tips on how to lie more effectively? Classy.

Don't worry, she's not working...

 

[Sparda29]

The DEA needs to go away.

 

[Angela1234]

It's society that does it. Who would have thought I would have to look at a sign near drop off that tells us what characteristics to look for in case of a robbery.

 

[crossurfingers]

I wish that there would be actual guidelines for every pharmacy to follow. For example, no prescriptions are filled earlier than 3 days. I have had so many people argue with me about how different pharmacists let it go out earlier and why don't you, blah blah blah.

They should just have DEA agents screen all these prescriptions to determine which ones are legit. It would cut down all the time we spend investigating and arguing. And maybe it would decrease the number of forgeries if people know they can actually get into trouble for it.

 

[BidingMyTime]

Then just fill it. What's the problem? Again, as long as its not something insane such as morphine #240, ill fill it. I wouldn't even call.
And, Likewise, if its something asinine like perc 10/325 #180, I won't fill it. I wouldn't even call the prescriber. I just say I don't have it right now and it takes 7 business days to order a quantity as large as that because it has to be verified by the dea.
Once you say that, the junkie will grab the script and run out the door.

Pharmacist judgement should be used, instead of blindly denying all prescriptions. In my state, public aid will not pay for Oxycontin without a PA, and the PA's are denied 95% of the time. So while its not common, it's not unheard of, for doctors to write for oxycodone/apap every 4 hours around the clock, because the pt can't afford to pay for oxycontin.

There is so much that goes into making a judgement call, is the patient a regular pt, do they fill non-controlled RX's, how much of their history is known, how well is the prescriber known, etc.

I have no problem telling a patient that I won't fill a prescription, because I believe the dosage is to large and could be harmful to them. But I don't automatically deny unusual prescription either.