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    When valid prescriptions are refused

    How patients can file complaints

    Drug Topics contributor Steve Ariens is a nonstop crusader for the rights of pharmacists. A cause about which he is equally passionate is the suffering inflicted upon chronic pain patients denied access to the medications upon which they depend and for which they hold legitimate prescriptions. He has warned in the pages of Drug Topics about possible consequences for pharmacists who refuse to fill valid Rxs. Now he offers a page of simple instructions for patients on how to file complaints. 

    Steve AriensSteve AriensIf a patient is denied a medication upon presentation of a valid/on-time prescription for a controlled substance, that patient may be eligible to file an ADA complaint.

    If the patient is disabled, as determined by coverage under Social Security, Medicare, or private disability insurance, that patient is covered under the Americans with Disabilities Act (ADA). Many chronic pain patients meet this criterion.

    The ADA parallels the Civil Rights Act of 1964. People who are disabled cannot be discriminated against because of their disabilities.

    Steven R. Ariens, PD
    Steve Ariens is a pharmacy advocate, blogger, and National Public Relations Director for The Pharmacy Alliance ...

    18 Comments

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    • Anonymous
      I'm an RN AND a chronic pain patient. I have also worked as a triage nurse, and I can tell you that 90% of the people with horrendous physical problems look OK. You really can't size people up by looking at them, just like you can't size up child abusers and spouse abusers by looking at them. Certain pharmacists have treated me horribly, apparently because I do not look sick enough, or because I seem too "spaced out" to them. They don't bother to ask me any questions; if they did, they would find out I'm not "spaced out;" instead, I'm exhausted from working 10 1/2 hour shifts and that my pain meds make me tired, not "high." But you can't win with the pharmacists. They are always looking for some tiny shred of evidence to support their prejudices against narcotic pain medication. I have scarring on my sacral nerve that causes intense burning pain in my genitals 24 hours, 7 days a week. I was ready to commit suicide before I was referred to my pain doctor. I am thankful everyday for my pain medication. I have tried acupuncture, physical therapy, meditation, Tai Chi, QiGong,meds for neuropathic pain such as Elavil, gabapentin, lyrica, topamax, etc. (due to liver enzymes I am a slow metabolizer and most meds for neuropathic pain do not work for me and instead make me ill) and am getting ready to try massage therapy. Everything helps a little, but only narcotics make my life liveable. Opana does not make me high, it just makes me tired. No pharmacist has the right to decide it shouldn't be dispensed to me. My pain doctor has spent FOUR YEARS trying different modalities to relieve my pain, and some pharmacist can just come along and say "Nope!" to a prescription? That's ridiculous!
    • BILLSARRAF
      wow... I was going to jump in with my usual brilliant insight but it seems like all the right points have already been made. Sorry, Steve. I like reading your blog and your articles but I find it increasingly difficult to agree with your viewpoint on this subject. We are not here to not fill prescriptions. Pharmacists know what to do and we can tell the good ones from the bad ones.
    • Anonymous
      Do you for 1 second believe pharmacist do not want to fill a prescription for someone in need. Sure there are a very small amount of mistakes made when a so-called legit Rx for a person in true pain is not filled. But in all cases the person should have taken responsiblity on where and how they get the rx filled. Maybe just Maybe even the MD who is writing the Sch 2(we all know these are rxs you are talking about) should take some responsibility in educating the patient. None of us went to school or want to be the police but it seems noone else is doing the job! As a now partime pharmacist who has work at alot of stores the problem is all the so-called legit rxs that are being filled.
    • Anonymous
      I was taught since pharmacy school that I have a "right to refuse" to fill any prescription for any reason I deem necessary. I refuse to fill any prescriptions for someone that is verbally abusive to me or my staff. I refuse to fill any oxycodone prescription that the customer asks for the M's or the A's. I refuse to fill any prescription that reimburses well below cost. I feel my right to refuse is just as important and necessary as any other civil rights we have.
    • Anonymous
      Steve, It is obvious you don't work behind a counter for a living. I trust my instincts and 27 years of experience. If you or any patient don't like my decision call anyone you wish....you whine about the patient with a "timely" prescription, but what about my corresponding liability? Sure Pharmacy as a profession and Pharmacists as practitioners have problems with PBMs, insurance companies, etc. but we also have problems from self proclaimed "expert" desk jockeys like you that want to dictate policy from a desk without ever having real world experience in solving real world problems.
    • Anonymous
      As a pharmacist and the husband of a chronic pain medication patient, I see both sides. I have refused prescriptions that were questionable that I could not validate. I can also say that my wife has often felt and been treated like a criminal by pharmacists when trying to fill her prescription for the first time at a new pharmacy. I wish this article would have addressed the real issues and solutions like, always use the same pharmacy. Make sure you fill your prescriptions at times that your physicians office is open for verification of prescribing. I think it is criminal what some physicians are required to provide to get a legitimate prescription filled for their patients at some pharmacies, it is one thing to follow up on a suspicious prescription, but something else to create global CYA policies that make filling legitimate prescriptions feel like a crime.
    • Anonymous
      As a pharmacist and the husband of a chronic pain medication patient, I see both sides. I have refused prescriptions that were questionable that I could not validate. I can also say that my wife has often felt and been treated like a criminal by pharmacists when trying to fill her prescription for the first time at a new pharmacy. I wish this article would have addressed the real issues and solutions like, always use the same pharmacy. Make sure you fill your prescriptions at times that your physicians office is open for verification of prescribing. I think it is criminal what some physicians are required to provide to get a legitimate prescription filled for their patients at some pharmacies, it is one thing to follow up on a suspicious prescription, but something else create global CYA policies that make filling legitimate prescriptions feel like a crime.
    • Mr. Albert J. Kalinin
      Steve, I guess someone has to advocate for diverters, seekers and drug addicts. Perhaps next you could author an article on how bank robbers, rapists and murderers can sue pharmacists.
    • Anonymous
      Spot on! Thank you, couldn't have said it better.
    • Anonymous
      Yes to what everyone has said, this article is a joke and an embarrassment to all pharmacists. Seriously?!?! We get poor reimbursement from insurance, disrespect from MD's and their staff, abused by patients all day but none of this comes close to one of our own stabbing us in the back. Tell me, do your efforts to punish your own get you any extra points from your MD cohorts in your cushy consulting job? Couldn't get into medical school? What is your problem? What we need from so-called "thinkers" like you who have time to write articles like this is real solutions for everyone involved. Thanks for setting us back more than few steps...
    • davidkeighley
      Very troll like article designed to generate a response, which it did. Like most pharmacists , I make an honest effort to follow, and keep up with the law, as well as my employers strict guidelines. I trust my instincts and try to be compassionate. I can't decide if the title PD means police department or per diem, but I doubt the authors experience involves any pharmacy work in a community setting. Perhaps it is a typo for JD.
    • MartinWiederkehr
      I practice in Florida and the regulations have always allowed us to fill prescriptions for our out-of-state tourists. That said, when presented with a controlled prescription it was always incumbent upon us to verify the validity of said Rx. In today's Pharmacy practice and to completely be assured of the validity of the Rx we commonly contact the prescriber to verify and always note the date, time and name of the person authorizing. There are many times that we won't fill a particular prescription, not because we feel it isn't legitimate but perhaps the prescriber is unknown to us and/or the patient resides 40 or 50 miles away. We tell them to have the Rx filled where they are known. Another problem we have is that we check each prescription with the state data base and we know that the data is wrong. It hasn't been updated and we can't see what or when they had the item filled last. A similar bone of contention I have is those Pharmacists who insert their religious beliefs into what they will or will not dispnse. The distributors have been put under a lot of scrutiny these past years but without any specific guidelines they made these arbitrary quota allocations. When it comes to about the middle of the month we cannot get any more of the CII's. So how do I tell my long time patient/customer that has a prescription for a pain killer such as Oxycodone that they have to wait two weeks until I get my next supply.
    • Michael VincentErcolano
      A prescription must be issued for a legitimate medical purpose and in the usual course of professional practice, otherwise it is not valid according to Federal Law. When a prescriber gives someone oxycodone 30 mg without first trying a less potent agent or dose to see if that will relieve the pain, it is not the usual course of professional practice, and therefore not a valid prescription. Mr. Ariens, you obviously don't work in retail like most of us do. You probably have some cushy desk job somewhere and you actually get to sit down at work. Do you even dispense any prescriptions at all? Because were I work, if you fill 2 oxycodone 30 mg rx's today, you will have 100 of them tomorrow, and the next day the DEA will be knocking on your door. Having said that, all of you pharmacists who say "I don't have it" when you do have it are liars and are perpetuating the problem. You can be penalized by the Board of Pharmacy for lying to the patient like that, but you have the right to refuse the rx if you think it hasn't been written according to accepted medical standards, ADA or no ADA. Mr. Ariens, you are not even offering a solution, and I'm not sure what your purpose was in writing this article other than to annoy people. The DEA and unethical prescribers are the real cause of this problem. The DEA is so ambiguous and vague and will never tell you it's OK or not OK to fill an rx and they have no specific criteria to define a valid rx, or how many rx's are too many. Therefore, most pharmacists would rather err on the side of caution instead of getting a huge fine and losing their license. Furthermore, we retail pharmacists (except most independents) have lost most of our autonomy long ago. We report to non-pharmacist managers who don't care about us, and boards of pharmacy don't want to interfere. Our predecessors allowed this to happen because they didn't want the responsibility and work of running a store and just wanted to stay in the back and fill scripts. And we traded good working conditions for higher pay (now the pay is going down and the conditions are getting worse). And then the insurance companies. Now our profession is going down the drain. We need to stand together and speak out against the injustices being done to us. Write to your congressmen, complain to your state board or your supervisor or whoever will listen because it's getting worse every year and soon we'll all be replaced by robots if we do nothing.
    • Dr. Zelman
      HIPAA? Are you kidding me? That's like saying "The man who assaulted me jaywalked across the street to beat me to a bloody pulp! Give him a citation for the way he crossed the street!" If you want changes made to the way pharmacists are dealing with drug addicts and quack physicians, stick to the actual issue.
    • Anonymous
      So who decides what is a legitimate prescription? My rule #1 is that I do not live in someone else's body so I do not judge nor is it my job to confirm diagnoses. Having said that I see so many questionable prescriptions for high dose narcotics from patients that look like models from yoga commercials or under 40's that move much easier than my 5 decade body ever will again. I live in an area that receives many visitors but prescriptions for 240 Roxicodone 30mg from anybody other than a local patient or physician will rarely get filled by me. I have been "threatened/warned" by my employer, state regulatory agency and the DEA about filling narcotic prescriptions so adding the ADA lawyers is no big deal. If I go to trial you can be damn sure the prescriber better have his records available for scrutiny as when I ask an agent of the state or DEA if a physician has been contacted or interviewed the answer is always "no".
    • Anonymous
      I commend the author Mr. Ariens for his thoughtful load of B.S. He does not work in Realville. He may be fine at developing software or working in a 6 physician office as a pharm D consultant on pain management (yes his resume is online). I understand he is an advocate for the pain management crowd. I believe in an aggressive stance on pain management; however, if I practiced in the way the author suggests I would have every doper in town on my front step. If I took mr. Arien's recommendations, I would blindly fill the doper combo of Xanax 2mg, Soma 350mg, Oxy 30, and Norco 10 for the 20-somethings that walk in off the street with "back pain" or "chronic pain" but there is no Lyrica, gabapentin, etc. By Mr. Ariens logic, I should fill this no questions asked as long as it's on time. There are bad doctors in this world (I've helped lock up several) and plenty of bad "patients". By Mr. Ariens logic, I should sell a box of 24 hour Sudafed to the 4 people in line in a row that came in together. Pharmacists do have a reasonable responsibility to prevent drug diversion. It is bad that some people get caught in the crossfire but how dare you, Mr. Ariens, try to nail your "supposed fellow pharmacist" for trying to do the right thing. Do you know Mr. Ariens that a script for 120 oxycodone 30mg is worth about $4000 on the street? Do you know, Mr. Ariens how many deaths come from diverted medications? Did you know Mr. Ariens that there was a doctor in Oklahoma city that was sentenced last year to prison that killed over 93 patients? His people filled their scripts on time. I would think after working in the business for so many years you would not be as naive as you seem to be. ADA...really? Maybe in some cases, but not the majority where I am at. This is not a black and white issue. Come to Reallville and work in the trenches, Mr. Ariens. The dopers will love you.
    • Anonymous
      Anonymous, here in Florida we use a super-duper magic marker to identify patients who are truely in pain. It turns red if they are. Joking a side, I concur. Thanks to our DEA, there is not enough to go around. Each and every wholesaler limits CII's, benzo's and hydrocodone. That is the wholesalers that still deal with Florida. So the Federal government, who has their jack-booted foot on the wholesalers, can go after me with this author's help? Some of us compound ocycodone and hydromorphone while working in concert with the physicians and the DEA is in the process of snuffing that out. In Florida, we are on our way to legalizing pot and criminalizing FDA aoroved medications. Thank you government.
    • JACKPADGETT
      Does the pharmacist have the right to refuse a legitimate prescription when the PBM pays $25.00 less than cost or can he just say we are "out" of this drug? The PBM is denying the drug not me as my independent store cannot and will not fill prescriptions like this. There needs to be a national law that PBM's must update prices daily or at least weekly and that if a pharmacy shows they paid a higher price it must be honored. I filled a RX, after hours for 90 furosemide 40 MG, a 90 day supply and my total reimbursement was $1.04. Now in all fairness would a PBM fill and mail a Rx to a member for $1.04 for a 90 d/s. I have come to realize that there are some Rx's I just cannot fill so I send them to my competitors the chains. They fill them no questions asked and this my friends is why pharmacy finds itself in the position it is in today. Our patients may love us and respect us but the insurance industry and the PBM's have no respect for us at all, and they shouldn't. We are our own worst enemy and it gets worse every year. My years are winding down but I feel very sad for the younger pharmacists that have spent 6 years of their lives, are well trained and face these challenges.

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