Walgreens’ “secret checklist” reveals controversial new policy on pain pills

http://www.wthr.com/story/23469086/2013/09/18/walgreens-secret-checklist-reveals-controversial-new-policy-on-pain-pills

Walgreens patrons across the nation told Eyewitness News their prescriptions were being delayed or denied because of a new pharmacy policy, but Walgreens would not tell them what the policy is.

WTHR has obtained an internal document the nation’s largest drug store chain has been trying to keep secret. It reveals why Walgreens is now turning away some customers and refusing to fill their prescriptions.

“We were told patients are not supposed to know we’re using [this],” said pharmacy technician

Walgreens’ one-page checklist must be used by its pharmacy staff each time a  customer presents a prescription for a powerful narcotic. Oxycodone, Methadone, Hydromorphone (Dilaudid), Morphine, Fentanyl and Opana are included on the list of Walgreens’ “target drugs” because they are all highly-addictive controlled substances that government regulators have placed in a high-risk category for prescription drug abuse.

According to the GFD checklist: a pharmacist is required to complete four mandatory steps before filling a prescription for one of the GFD Policy target drugs:

  • Check Walgreens’ national Itercom Plus computer system to confirm the prescription has not been previously denied by another Walgreens pharmacy

  • Review a customer’s personal prescription drug history maintained by a state Prescription Drug Monitoring Program (PDMP). In Indiana, the state tracks all residents’ opiod prescriptions using an online PDMP system called INSPECT.

  • Photocopy a valid government photo ID for the individual(s) dropping off and picking up each prescription

  • Answer a series of seven questions about the prescription, patient and prescribing doctor to look for “red flags” of possible prescription drug abuse

The additional seven questions include:

  • Whether the patient has previously received the same medication from Walgreens (new prescription or new patient is a red flag)
  • Whether the prescription is written for the same medication and from the same doctor as the previous fill (new doctor is possible red flag)
  • Whether the patient and doctor listed on the prescription are within close geographical proximity to the drug store (far distances that cannot be explained are a red flag)
  • Whether the prescription is being filled on time (attempt to fill early is a red flag)
  • Whether the patient is paying for the prescription using insurance (cash is a red flag)
  • Whether the quantity of pills prescribed is considered excessive (more than 120 pills is a red flag if paying by insurance; more than 60 pills is a red flag if paying cash)
  • Whether the patient has been taking the same medication and dosage for a long time (more than 6 months is a red flag)

Based on the results of the previous steps and questions, Walgreen’s checklist instructs pharmacists to use their “professional judgement” (sic) to determine whether the prescription should be filled or the pharmacy should take the additional step of calling the prescribing doctor to ask more questions.

If a call to the physician is needed to further verify the prescription, the checklist directs Walgreens staff to “verify/confirm any number of the following points” with the doctor:

  • Prescription is written within prescriber’s scope of practice
  • Diagnosis
  • Therapeutic regimen is within standard of care
  • Expected length of treatment
  • Date of last physical and pain assessment
  • Use of alternative/lesser prescription medications for pain control
  • Coordination with other clinicians involved in patient care

The Walgreens checklist is designed to help pharmacists identify prescription fraud and to keep addictive drugs away from those who abuse them.  But critics say it’s been keeping pain pills away from the people who really need them

If a Walgreens pharmacist refuses to fill your prescription for pain medication, that denial must now be entered into your online customer profile that can be seen by pharmacy staff at more than 8300 Walgreens nationwide. According to the GFD Policy, Walgreens pharmacists will also notify the US Drug Enforcement Administration that your prescription has been refused, and the pharmacy must maintain detailed documentation to justify the reason.

But if you want to know why Walgreens denied pain medication prescribed by your doctor, you’re out of luck.

The company introduced its Good Faith Dispensing Policy and GFD checklist earlier this year as it was embroiled in a massive investigation by the US Department of Justice and US Drug Enforcement Administration.  Federal agents targeted six Walgreens drug stores and a Walgreens distribution center in Florida, where they caught the company repeatedly filling bogus prescriptions for pain pills.

Walgreens agreed to pay an $80 million fine for those violations, and as part of its settlement, the company promised to improve its policies and procedures to help reduce prescription drug abuse involving addictive pain narcotics. That’s when Walgreens rolled out its GFD checklist, and told its employees to implement it – quietly.

The truth is, a lot of bad prescriptions still get approved because the pharmacy manager’s bonus is based on the amount of scripts that get filled.”

Ryan said the GFD Policy was applied inconsistently, with prescription approvals and denials based upon the subjective decisions of the particular pharmacy staff on duty.

Ryan is not alone.  Many doctors also believe Walgreen’s checklist is problematic. Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation, told WTHR she is both disappointed and shocked to learn what Walgreens is doing.

Peel believes Walgreen’s policy discriminates against millions of people, based solely on the type of medication they need. “Everyone — everyone — who has a pain prescription is being treated as a suspected criminal,” she explained. “We need programs that target the abusers, that don’t treat everyone as an abuser. That’s the real problem with this. It’s highly offensive.”

The longtime pain specialist offered the following explanation: “They want to know ‘expected length of treatment?’ I have no idea a lot of times how long it’s going to take to treat pain. The length of treatment may be forever for some patients. “Is the therapeutic regimen within standard of care? Many of the medications we prescribe are ‘off label’ because no other therapy has worked. “Use of alternative prescriptions and lower doses? Patients that are on higher doses than normal may actually need those doses because of the way that genetically their body works. “My concern is: is this a checklist or is this a diagnosis list? Because I don’t think many pharmacists are trained or equipped to really understand the diagnosis. Pain is a very difficult entity to treat.”

The organization responded by creating an online complaint form for doctors and patients who are experiencing difficulty in getting prescriptions for controlled substances filled at Walgreens.

The American Medical Association is also tracking the problem.

“Physicians in more than 20 states tell the AMA that several national pharmacy chains may be inappropriately restricting patients’ access to legitimate pain medication. Such roadblocks are creating serious barriers to patient access to needed medications – including those in hospice,”

See the Walgreens checklist and Good Faith Dispensing Policy.

Having trouble getting a prescription for pain medication filled at Walgreens? File a complaint here.

By using the phrase “use your own professional judgement” Walgreens is asking their pharmacists to practice medicine – isn’t that illegal?

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16 thoughts on “Walgreens’ “secret checklist” reveals controversial new policy on pain pills

  1. joynpain2

    I am so glad I use an old fashioned mom-n-pop place. They get to know you, they know the issues you’re going through, so there’s never any type of discrimination even from the staff. I recently moved and my pharmacy is now a 10-15 min drive instead of a 3 min drive, but it’s worth it to me to know that I’m not just a number to them. I am a friend and they do what they can to help. Just another blessing to be remembered daily.

    Reply
  2. ila brumback

    Have been filling my opioid pain meds (prescribed by Pain Mgmt Specialist) for over 1 year at Walgreens every 30 days. Just took in prescription and was later called by pharmacist informing me they would not fill script until they had additional info from the Dr. Unbelievable – after the history I have of being on the meds prescribed by a legitimate Dr. for a legitimate reason Walgreens now decides to question my prescription so I am forced to wait until they contact my Dr. Which in the meantime means I could run out of meds that are NEVER supposed to be stopped without tapering off the meds – along with the pain. It is terrible enough to suffer from pain 24/7 but to now be treated as a drug addict adds insult to pain. I am done with Walgreens

    Reply
  3. forevershea37

    I had been using Walgreens in a small town just outside of Birmingham for about 20 years. My Pain Specialist doctor mailed my prescription to them each month when it was due. I knew the pharmacists and staff and never had any problems.

    We moved from Al back home to LA in April of this year. I immediately began seeing a reputable Pain Specialist in the area. Walgreens turned down my prescriptions but did finally find another Walgreens store that could help me with one of my pain meds. The second pain med I had to cold turkey off of because not one of the chains in the area was even allowed to order it for me. I was treated like a criminal everywhere I went but oddly enough Walgreens did try to order it for me but could never get it delivered.

    I talked to the manager of the closest Walgreens to my home, and she agreed to order my morphine for me each month. I have to talk to her each time it is filled, show my driver’s license and call her to remind her to order it for me they are running low. While I was unable to get my second pain med from any chain, I am at least very greatly appreciative that this Walgreens will help me and while some of the staff acts skeptical, the manager understands my unique case and has been more than helpful.

    I guess I passed the white glove test. But, it is very disturbing to me that this practice is causing so many sick and suffering patients to endure such poor treatment. I am for stopping drug abusers but to punish all patients because of law breakers, is not fair. It all has to do, I think, with the attitudes of pharmacy staff and their unwillness to treat each patient fairly and not assume the worst in every case. Human compassion should always prevail unless proven otherwise.

    Reply
    1. Already been black balled!

      You may want to speak to your pharmacist because unfortunately; they may end up having to black ball you too. Read over the list; if you’re on one of the meds longer then 6 months; you’re going to fail too. All it takes is your regular pharmacist being out of work one time.. You will not be allowed to use any Walgreens ever again.

      Reply
      1. Zyp Czyk Post author

        I’ve been getting my consistent opiate scripts filled at one CVS pharmacy since 1995 and have had no problems… Yet. I’m sure this would change if I tried to use a different chain (or even branch?), but so far I’ve been lucky.

        It might help that I live in Silicon Valley where folks might be a little more enlightened than in the back woods of Kentucky where the problems with opiates are worst. It’s crazy that our quality of life is at the mercy of whatever individual wants to stop us from getting pain relief: doctor, nurse, pharmacist, or even pharm tech. Bureaucrats and other non-medical personnel have more power over our lives than we have ourselves when it comes to pain.

        Reply
        1. Already been black balled!

          It’s getting to be all over from what I read today; although most aren’t like Walgreens. I’ve been to one food store chain that told me they’re not accepting any more patients with certain meds.

          Reply
  4. Zyp Czyk Post author

    It seems the rules are so vague that individual pharmacists can decide how intensely to question opiate prescriptions. There shouldn’t be different policies at different branches of the same chain, and it demonstrates the confusion the DEA has caused with its inconsistent enforcement. No doctor or pharmacist can be certain that opiate prescriptions won’t cause them trouble. Perhaps that is the idea: to scare everyone away from opiates.

    Vague laws are prone to an abuse of power. The vagueness allows powerful people to interpret the rules from their own point of view, according to their own personal beliefs and biases. That seems to be what’s happening with the DEA and opiates.

    Reply
    1. Already been black balled!

      I’ll post my full experience when I get back; been a customer of Walgreens since 2009; spending close to $10,000.00 (yes TEN THOUSAND) a YEAR out of pocket due to the meds I’m on. This does not include my daughter & hub which added probably another $5,000.00. Mine was out of one med; was lazy & decided to fill at the one I use for hub & daughter as well as my other non-pain meds.. This dude black balled me; not caring that I’ve been a loyal customer since 09; did not care how much I spend nor that I’m going to pull all of our scripts.

      Reply
  5. Pingback: Florida Pain Victims Trapped by Prescription Crackdown | EDS Info (Ehlers-Danlos Syndrome)

  6. Already black balled

    I have been a customer of a store that is not local to me since December 2009. I have spent $10,000 out of pocket on just myself; not including my husband & daughter due to maxing out my insurance. There has been a shortage of one of my pain meds; I had to fill it at my local store last month; I had no issues. Weds 12/4 I called my store to see if my one med was still back ordered; was told yes; so I dropped my scripts off at the local store for next day fill.

    Thursday 12/5 9:07 am, I received a text saying my scripts were ready. 11:19 am, I was getting ready to leave when the store pharmacist called saying he refuses to fill my prescriptions; that I do not meet their criteria for one medication because manufacturer says 2 times per day; I take it three times per day; I needed to come pick them up & find another pharmacy to fill them. I mentioned that my other med is out of stock and back ordered all over; I do not understand why he was doing this to me when I’ve been a loyal customer since 2009. He coldly said he did not care; he said I know you have; you do not fit our criteria.

    I called the 1-800 number; explained the situation to them; I was told that yes; pharmacists can refuse to fill prescriptions; but that I can take it to another Walgreens store or bring it back there later when another pharmacist was on. They said there was nothing they could do as it was his license.

    I was satisfied that I was only banned from one pharmacist; I went to pick my scripts up and to speak to Mr rude pharmacist; thinking he would understand why I’m dosed like that. I have a failed lumbar fusion; fused from L5S1 to my sacrum. I am allergic to a lot of medications; antibiotics; Lyrica; morphine. Not only that; I have not been able to tolerate doses that others can. I am not able to go to the next dose up in order to take 2 pills per day because the dose is too much for me; but taking the dose I am on 2 times per day is not enough; so I was put on the medication 3x per day; have been on it for years; it works for me.

    I explained the doses to rude pharmacist; as well as my allergies; he was rude; turned his head & walked away muttering something that I won’t be getting my scripts filled at ANY Walgreens. I asked one of the techs when the next pharmacist was coming in because corporate had told me I was only banned from him filling my scripts; I was told 2pm; rude pharmacist said well; corporate is wrong; they need to learn the rules.

    It was around 1pm when I then drove to my store to fill my script I was told that they are not allowed to fill my scripts any more because of what rude pharmacist did to me. I’m crying pretty hard at this point, I asked to speak to the manager who knows I am a good customer of Walgreens; he was very empathetic to me but said it is out of his hands; there was nothing he could do.

    I then drove to every pharmacy around; I hit I think 8 pharmacies; every one was out of both of my medications. I stopped driving around at 4pm. I finally called a place 40 mins from me who was nice enough to tell me they had it before driving there for nothing

    I PM’d Walgreens FB page with this same story except it had store numbers & names asking for a copy of this policy. I said i do not understand how Walgreens is giving this type of power to one pharmacist. You would think that me being a loyal customer since 2009; as I said; I spend major money there between scripts for 3 people; as well as all our OTC & whatever else I purchase… There was no courtesy where the pharmacist speaks to me; saying I do not meet his or company criteria to allow me to stop going there without making me feel like a CRIMINAL?

    I have never been treated so poorly as I was by this pharmacist who has a God complex. I will be writing letters and filing complaints.

    Reply from the FB page; notice the word inappropriate – Thanks for responding Ms. Been black balled. I’m so sorry to hear of your experience. Each pharmacist has a corresponding responsibility for decisions that impact patients’ health. As a result, each pharmacist has the obligation and discretion to exercise his or her professional judgment in dispensing medication. Walgreens stands behind the judgment of its healthcare practitioners anytime they feel it is inappropriate to fill a prescription. Walgreens will not and cannot require a pharmacist to compromise his or her discretion. Thank you and be well. Nancy

    Reply
    1. Zyp Czyk Post author

      Hmmm… I thought pharmacists were professionally required to fill whatever legitimate scripts are handed to them.

      Isn’t this similar to the cases involving pharmacists refusing to fill birth control scripts? In that case, I believe they were told that it was their professional duty, regardless of their personal beliefs, to dispense birth control, and if they could not bring themselves to do it, they should perhaps find a different profession. The difference I see is that the BC case involved “personal beliefs” versus what they now call “professional judgement”.

      Of course, we know this IS about personal beliefs, but now cloaked in terminology appealing to the opio-phobes. It’s impossible to prove that your pharmacist was motivated by personal, and not professional, judgement so this nifty excuse will probably remain unchallenged.

      I wonder what other powers of “professional judgement” pharmacists will exercise next?

      Reply
      1. Already been black balled!

        My question is; who are these meds for if not for people like us? My pharmacy had already gotten the necessary paperwork from my PM Dr back when this 1st started although they did not tell me what was going on; except that it was some new policy. When I read the article; I knew that’s what happened.. My pharmacy has been great filling it; I will go back there next week to request a copy of our records to include it with a letter to corporate. I’m going to ask them at what point would they have had to black ball me… I’m sure it would be coming.

        When I went to my pharmacy that day; I did not tell them what happened at my local store because I was sure I wouldn’t have an issue. My pharmacist was also very empathetic; she had gotten the manager for me to see if there was something he could over-ride; but once that rude pharmacist hits that red X; it can’t be taken away. I was told that rude pharmacist can’t even reverse it.

        Reply
  7. Pingback: 12 Most Popular Posts from 2013 | EDS Info (Ehlers-Danlos Syndrome)

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