Hello SDNers,
How do I further investigate......
Run the PDMP report and see how this patient buys drug. If you do not have password,
perhaps you
may ask you friend in the same chain to run for you. In general, HIPPA law allows health care professional to share confidential information to another health care professional for timely health care management. Your state may be slightly different.
In Wisconsin, dispenser can delegate another person to run the report, meaning: pharmacist can ask technician to run the report. (
http://dsps.wi.gov/pdmp/faq)
Here is the quote:
"Q: Can dispensers and practitioners delegate to another person the task of accessing and querying the PDMP for patient data?
A: Yes. Under the law, dispensers and practitioners may delegate the task of accessing and querying the PDMP for information. However, the licensed dispenser or practitioner has to verify the delegation and remains responsible for the delegate’s use of the PDMP."
In California, you can run yourself and give to another health care professional:
SOURCE:
https://pmp.doj.ca.gov/pdmp/cures_faq.html
- Who has access to CURES information?
- As defined in Health & Safety Code Section 11165(c) “CURES shall operate under existing provisions of law to safeguard the privacy and confidentiality of patients.” In July 2009, pre-registered users including prescribers, pharmacists, law enforcement, and regulatory boards will be able to access a patents prescription history in order to identify and prevent the potential abuse of prescription drugs. The Prescription Monitoring Program system provides patient activity reports in an effort to combat pharmaceutical drug diversion. The role of the Prescription Monitoring Program system trusts that well informed prescribers and pharmacists can and will use their professional expertise to evaluate their patients care and assist those patients who may be abusing controlled substances. Patent activity report information is available to licensed healthcare prescribers and pharmacists authorized to dispense controlled substances.
Data obtained from CURES shall only be provided to appropriate state, local and federal persons or public agencies for disciplinary, civil, or criminal purposes and to other agencies or entities as determined by the Department of Justice, for the purpose of educating practitioners and others in lieu of disciplinary, civil, or criminal actions. Data may be provided to public or private entities, as approved by the Department of Justice, for educational, peer review, statistical, or research purposes, provided that patient information, including any information that may identify the patient, is not compromised. Further, data disclosed to any individual or agency as described in this subdivision shall not be disclosed, sold, or transferred to any third party.
SOURCE: https://pmp.doj.ca.gov/pdmp/cures_faq.html
That means in California, you can share CURES report to other health care professional for the purpose of educating other health care professional about the drug use of this patient and therefore discuss the decision about: dispense or not.
In extreme cases, verifying that the script was indeed written is not enough if the doctor is pill mill doctor. This explanation came from a law office that represented a chain pharmacy:
SOURCE:
http://www.fdalawblog.net/fda_law_b...harmacists-corresponding-responsibility-.html
"Presented with the above evidence, the DEA stated that
even if the pharmacist
had verified
with the physician “each and every” prescription, the evidence showed he
still violated his corresponding responsibility because many of the prescriptions “patently served no legitimate medical purpose.” Id."
(Again, that was about extreme case of a pharmacist that blatantly and blindly filled script.)
Hello SDNers,
How do I reply to the patient and my PIC and my Supervisor? Please guide!
I have pharmacist in the district who refused to fill Birth Control.
I have pharmacist in the district who refused to fill Abortion therapy (Percocet, Doxycycline, Misoprostol....).
They are still working part time as relief.
Controlled Substance: That's a different angle.
Allow me to remind you, your District Manager has seen complaints about many refusals. The main issue here will be: how you refused and how strong your reason is.
The patient may make up stories and complain that you are rude or impolite. Therefore, during the conversation with your boss, you have to
give your boss no reason to think that you are rude or impolite. You need to present the nicest way of refusal and with reasons.
Imagine if you talk with your boss and you talk in confrontational tone, what would the boss think?
If this pharmacist is talking confrontational tone with me, perhaps this pharmacist is also confrontational during heated conversation with outraged patient.
See? Avoid that trap by being on your nicest behavior with your boss, at least during this explanation.
Now, back to technical refusal.
Arm yourself with news article about pharmacies being dragged into investigation because they blindly fill scripts from doctors that over prescribe.
Explain up front at the start of the conversation to your boss:
Boss, we are both on the same side here so allow me to share with you the reasons that support my action in the front line. First of all, I am very scared for us to be dragged into drug investigation by the drug police. I just read again last night about the the fact that the DEA suspended licenses of 6 Walgreens pharmacies in Florida until May 2014. That means 6 pharmacies can not sell any controlled substance for almost 10 months. That must really hurt business seriously and must have brought down profits for the whole district. Imagine the headache of attorney, court, evidences...That's why I am very careful so that we are not dragged into red flag cases. In this case, the red flags are.....
Red flag number 1 is: Patient told me not to try Medicaid because as pharmacist, once we try to bill Medicaid and we find out the medication is being refilled early, we can not fill early even with cash. Pharmacists in general often refuse script for the reason that the script is "too early to fill" and maybe that's why this person is hiding the fact that this medication is too early to fill.
Red flag number 2 is: I reviewed the DEA law and found out that currently, the DEA, drug police, has official regulation stating that the pharmacist will be prosecuted if we blindly fill prescription that is questionable and has no valid legitimate medical purpose. DEA’s regulations (21 C.F.R. § 1306.04 (Code of Federal Regulation) mandates "Pharmacist Corresponding Responsibility". This means pharmacist must verify that the doctor is not blindly prescribing outside of usual scope of practice and standard of care and the law also further stated that any pharmacist who blindly fills will be held to the same treatment with the doctor in the court of law.
SOURCE: http://deachronicles.quarles.com/20...ng-responsibility-and-red-flags-of-diversion/
"In layman’s terms the regulation states that the pharmacist is in the same position as the practitioner who issued the prescription (but without having actually conducted a medical examination of the patient) and must exercise professional judgment to determine whether a prescription for a controlled substance was issued for a legitimate reason........it is clear that a pharmacist cannot simply defer to the prescribing practitioner and must exercise his/her independent judgment when determining whether a prescription was issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice."
SOURCE: http://deachronicles.quarles.com/20...ng-responsibility-and-red-flags-of-diversion/
Finally, the drug police (DEA) stated this:
SOURCE: http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm
"The law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately ignores a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances. Such action is a felony offense, which may result in the loss of one’s business or professional license (see United States v. Kershman, 555 F.2d 198 [United States Court Of Appeals, Eighth Circuit, 1977])."
SOURCE: http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm
SOURCE: http://www.fdalawblog.net/fda_law_b...harmacists-corresponding-responsibility-.html
Those are reasons that supported my justifications to refuse to fill this red flag case. I did refuse very politely and the patient simply was complaining because patient did not get what they want.
Good luck....Now...the law is on your side...please look in your heart and find a good nice way to present to patient who is in pain...
