It has been reported by your publication and others that recently DEA suspended three Cardinal Health distribution centers
in Washington, Florida, and New Jersey from selling controlled substances due to their failure to adequately monitor "suspicious"
accounts. I would like to share our pharmacy's experience with Cardinal following these developments so that other pharmacist
owners/managers can learn from our experience.
Initially, Cardinal's only "option" was for a subsidiary, ParMed (New York), to distribute a very limited number of generic
opioid products to pharmacies in Washington state. The company had no better contingency plan in effect to cover the loss
of the Auburn, Wash., facility (no other distribution centers were licensed in Washington state). Had the entire facility
been shut down due to natural disaster (earthquake, flooding, etc.), over 600 Cardinal accounts statewide would not have been
able to obtain any medication for their clients.
It took several days for Cardinal to obtain emergency licensure of its Sacramento facility in Washington state (and several
accounts, including ours, provided assistance by calling our board of pharmacy to expedite this matter).
The week prior to the official DEA shutdown, Cardinal sales reps contacted their accounts (including ours), advising them
to increase their on-shelf inventory of controlled substances in order to cope with the pending logistical nightmare. In our
case, we significantly increased our controlled substance inventory in order to provide continued support for our patients.
This also happened to be just before our annual inventory, but being a hospital-owned and on-campus facility, we really didn't
have any choice but to raise our inventory of these products regardless of the financial consequences. Then, perhaps in order to placate the DEA and show the agency that it really had a process to identify scofflaws and diverters,
Cardinal cancelled the ability of several West Coast accounts (including our outpatient pharmacy department) to order controlled
substances. This jeopardized our pharmacy's ability to support our hospital's discharging surgical, inpatient, hospice, and
oncology patients. Notification from Cardinal came in the form of a fax sent by the corporate director of quality and regulatory
affairs late on a Monday (after the sender, based in Ohio, was no longer available for contact). The fax stated that our
account was cancelled in part due to "recent excessive quantities ordered" as well as "a risk that diversion will occur if
we continue to fill controlled substance orders."
It took several days to fix this with Cardinal. To be lumped by your wholesaler into the same category as an illegal Internet
operation is both personally and professionally insulting. This is especially insulting since we'd been advised by Cardinal
reps to increase our orders!
The lessons learned here are many and include researching just what your wholesaler's contingency plans are in the event of
emergency or disaster, making sure the wholesaler has a real plan to prevent diversion, and making sure your local sales rep
will be able to intervene on your behalf when situations like this arise.
And they continue to arise: Cardinal's most recent pronouncement is that now it can't supply Allegra-D from the Auburn, Wash.,
facility since it contains a controlled substance. So the problem continues.
Richard Molitor, R.Ph.
Manager
Evergreen Professional Center Pharmacy
Kirkland, Wash.
rmolitor@u.washington.edu
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