CVS to refuse controlled scripts from certain FL physicians

      I have a question for all pharmacists:  have you ever refused to fill a prescription that you judged to be questionable for any reason?  Have you heard of any other pharmacist exercising their professional judgement and refusing to fill a prescription themselves?  Now what about an entire chain refusing to fill controlled substance prescriptions written by certain physicians?  Well, the latter is exactly what is happening now in the State of Florida.

     Florida is one of the states with a hotbed of problems related to the illegal distribution of prescription narcotics.  One of the most common ways powerful pain medications are sold illegally is through so-called pain management clinics.  These “pill mills” as they’ve been labeled disguise themselves as legitimate pain clinics.  In reality, these pain clinics are illegal drug distribution centers contributing to our country’s drug diversion problem in a big way.  

     The problem of illegal narcotic distribution is so bad in south Florida that there are hundreds of pain management clinics scattered across the retail landscape.  These clinics will gladly give out pain pills to anyone who pays their fee.  This disregard for proper prescribing prompted Florida to enact new laws and set up a narcotics monitoring program to try and curb their growing drug distribution problem.  Narcotic prescriptions were getting to patients illegally in the state all too often. 

     This prompted CVS/Caremark, which operates CVS pharmacy stores in Florida, to take their own action against doctors that were loose with their narcotic prescribing habits.  In an unprecedented move, CVS sent letters to the DEA and to certain physicians explaining that the chain would not longer fill prescriptions for controlled substances for some doctors in Florida.  According to the St. Petersburg Times, the list included names of prescribers under watch by the company because of their unusual prescribing habits.

     I know where CVS is coming from here.  I’ve had instances in my career where I didn’t feel comfortable filling prescriptions for certain doctors who I felt were reckless with their prescribing habits.  I can remember one specific instance where a physician would routinely write for high dose amphetamines for a large percentage of  his patients.  I challenged him and questioned his judgement on more a couple of occasions.  I even refused to fill a couple of really high dose prescriptions he wrote and begged those patients to go get a second opinion.  But nothing changed and eventually I backed down from my stance against this prescriber.   To this day he still writes for controlled substances routinely at very large doses. 

     Another prescriber, who happened to be a dentist, tried to write for controlled substances like sleeping pills for family members including his wife.  Those kinds of prescriptions were out of his scope of practice but he insisted that he was perfectly within his right to prescribe such medications.  I held my ground and refused to fill the controlled prescriptions for his wife and this dentist went elsewhere.  But in the end what did I really accomplish?  Didn’t he fill those prescriptions right down the street? 

    CVS/Caremark has a big presence in the State of Florida.  According to information from their own website, CVS operates 713 pharmacies in the State of Florida including 44 that have MinuteClinic services for patients.  That is a lot of locations to deny filling controlled prescriptions from certain doctors.   CVS is in uncharted territory here making this proactive stand. 

    And as you might expect, this move by CVS did not come without some backlash from the medical community in Florida.  Some prescribers have already started directing their patients away from CVS pharmacies.  And some owners of pain management clinics in the state worry this move could deny legitimate pain patients their medication.  But will this move by CVS really hinder legitimate pain patients from getting narcotics? 

    Though it isn’t clear how many physicians were actually on this list CVS sent to the Drug Enforcement Agency (DEA),  CVS claims that there were only a “small number” of doctors that will be affected by the new policy.  It’s also unclear at this time if CVS has any plans to expand the policy to include other prescribers in other parts of the U.S. 

    Has CVS gone too far in an attempt to curb the illegal drug distribution problem in Florida?  Will this do any good even if the company is right?   Won’t these patients simply take their prescriptions to other pharmacies?  I just wonder how much this move will really do towards stopping the underlying problem. 

     At the least, this is a new strategy in the fight against illegal drug distribution.  CVS is taking a moral stance against the practice of pill mills handing out narcotics to anyone that walks in their doors.  But I wonder if this kind of move will have any meaningful impact on the amount of illegally prescribed drugs in the State of Florida?  My gut tells me this will do nothing to solve that lingering problem. 

     So what can be done to help stop the illegal prescription drug trade that is disguised as a legitimate pain treatment centers?   Should a retail pharmacy chain like CVS take a stand and single out certain doctors and refuse to fill their narcotics prescriptions?  What else can be done to curb this problem that seems so out of control?  What do you think? 

The Redheaded Pharmacist

36 Comments to “CVS to refuse controlled scripts from certain FL physicians”

  1. By BigTechRx, December 1, 2011 @ 7:29 am

    I say kudos to CVS. Even in other states MDs write ungodly quantities of CIIs. The CVS system (an internal software devlopment called RxConnect) stops data entry if a prescriber is under investigation by the state board. It’s time we stop the pill mills and start using prescription monitoring programs.


  2. By oldrphbs, December 1, 2011 @ 9:02 am

    While I appreciate CVS’s intentions on this and may applaud any attempt to control abusers, this decision is one for the individual Pharmacist to make on a case basis. It would be great for CVS to warn all stores about these doctors and recommend not filling for them. I would bet they have a non-overridable block on those doctors. The CVS computers will probably not fill for them. It should only be up to the Pharmacist to make those decisions as a matter of principle. It is a slippery slope and CVS has already taken too many decisions from the Pharmacist. It is only a short step away before we are told TO FILL a script we have already refused for abuse OR DUR reasons. Then again, in this particular case, I am ~800 miles from Florida and it has not yet been an issue.


  3. By BCMIGAL, December 1, 2011 @ 12:46 pm

    Where in RxConnect does the system stop data entry re mds who are under investigation? That must be a new function.
    Our district leaves it up to the individual pharmacist whether or not to fill an rx. We had ‘list” of suspicious prescribers, but our DM threw it away. After refusing to fill certain pain meds for 20 some year olds from doctors 40 miles away, I think the word is out not to come to our store. I applaud CVS for taking a stand. But I am surprised that they would risk possible bad publicity.

    Here is what California has in place:

    I know this is active because we have been contacted by the DEA about certain patients and prescribers.


  4. By Jerzy, December 1, 2011 @ 1:09 pm

    So, CVS plays cops now? Only in this country!


  5. By LD50 placebo effect, December 1, 2011 @ 6:25 pm

    When I refuse to fill a prescription, I generally write a note in ink on the back stating why I refused to sell it. That way, there is no mistake that a pharmacist looked at it and made a professional judgment about filling it. When I get a phoned in script that I feel is a fraud, I call the doctor involved on another line just like we were taught in pharmacy school. As for policies by chains to fill scripts written by certain docs, I am not so sure that I applaud the idea, as it seems to be taking the individual pharmacist decision-making away from the pharmacist. I would applaud the chain if they backed up a pharmacist in not filling a script if a situation warranted the decision, especially if the AMA backs up the individual pharmacist that refused to fill the prescription.


  6. By BCMIGAL, December 1, 2011 @ 7:02 pm

    Not a very official looking letter. And the corporate office is in Rhode Island. Northbrook has an operations center for Caremark. If you call the phone number, a live person answers. We do not even get that from our helpdesk. So what is really going on here?


  7. By IAPharmer, December 1, 2011 @ 8:41 pm

    Well, I am on the opposite end of the county and I have people that fly down to get those Rxs and then drive 3 hours to get to my state and try to fill them. If you call those clinics it takes 2 days for them to get back to you!

    I have a blanket policy that I will not fill narcotics from FL, plain and simple.


  8. By Pharmaciststeve, December 1, 2011 @ 9:55 pm

    The solution to put a sizable dent into the diversion market is sitting right on your Rx counter. What we need is to be able to validate on all NEW PATIENTS.. their driver’s license and SSN in a state/national database. If the pic on the computer screen from the state’s database does not match who is handing you the Rx.. both the Rx and the driver’s license should be confiscated.
    These database already exist, the cost to allow healthcare professionals to access them should be small.

    Delaware just passed a new law
    because someone passed a forged C-II using a forged ID using a drive thru window.. notice that the law was passed because the person passing the forged items could not be identified by the store’s camera

    Does this suggest that the war on drugs is more about arresting those that would divert than preventing diversion?… It would seem that there is more job security in arresting than prenventing


  9. By pharmacy chick, December 3, 2011 @ 1:24 am

    along the same lines as Walgreens dumping ExpressSCripts, its nice to see a huge chain stepping up and making a statement.


  10. By BigTechRx, December 3, 2011 @ 9:48 am

    I didn’t even think about the RPh’s role in this (I’m a tech). Sorry RPhs! I do agree with oldrphbs when he/she says:

    “this decision is one for the individual Pharmacist to make on a case basis.”

    Let’s expand on this. RPhs: in Ohio, techs are not permitted to have access to the PMP (OARRS). Do you think if techs were allowed access, we could save you time by either having to check yourself or make phone calls? At least we could print the report and show it to you to save time. What do you think?


  11. By The Cynical Pharmacist, December 3, 2011 @ 11:57 am

    “CVS is taking a moral stance against the practice of pill mills handing out narcotics to anyone that walks in their doors.”

    C’mon.. do you really think CVS is taking a moral stance? I’d be willing to bet it’s a legal maneuver designed to escape liability should one of those docs be prosecuted.


  12. By The Redheaded Pharmacist, December 3, 2011 @ 2:54 pm

    Maybe you are right Cynical. I was trying to give CVS some credit here. But maybe they are simply looking to avoid liability. But how much liability would pharmacies have in these kinds of cases? To me it is the doctors that are the real problem. If you are handing presciptions out to anyone who pays your office visit fee then you aren’t practicing medicine. It’s a simple drug deal transaction at that point. CVS is probably like everyone else: tired of dealing with a problem that has gotten way out of hand.

    As for me, on the one hand I kind of wish CVS would let individual pharmacists make the decision to fill a prescription or not fill one based on their professional judgement and simply back them up after the fact. But on the other hand, it is encouraging to see a major chain trying to do something, even if it is just to prove a point or avoid liability. Will it do any good? Who knows? But at least CVS proved a point by starting this policy and drawing attention to those physicians in question.

    I personally think a major crackdown on these so called “pain clinics” is way overdue. You can’t fight a prescription drug diversion problem if it is the prescribers that control the access to those medication that are the underlying problem. I would like to see clinics closed and prescribers jailed for their actions but it is a rare case that ends with those kinds of punishments. Most of the time the doctors are left to continue to give out drugs indiscriminantly. And then people wonder why our nation has a huge drug abuse problem! I wonder why the problem isn’t worse considering how easy it is to get controlled substances if you really want them!


  13. By alabamaRPH, December 3, 2011 @ 4:01 pm

    I work in north Alabama and see scripts from pill mills in Georgia and Florida on a very regular basis. The majority of pharmacists in my district refuse to fill any out of state controlled Rx. I learned the hard way to not fill these. I took all the correct steps to call and verify the Rx and after I filled it 2 more people came in with the exact same Rx’s. Needless to say that was a first and last for me. I don’t mind the CVS policy because honestly, it would make it so much easier to tell patients no and hopefully keep them from getting angry and causing a scene which happens regularly. I am a fairly small female as are all of my technicians and store manager. We have almost had to call the police on some of these angry male patients.


  14. By New Tech, December 4, 2011 @ 7:13 am

    I work at a CVS in West Virginia and we have refused to fill rx’s from doctors in FL, GA, AL & MS. The people coming up here from there are driving brand new shiny expensive cars. One day before my shift, I had to drive past my store and saw a car just sitting there. When I got to work, the car was still there. As soon as the drive-thru opened, they pulled up. The script was from FL, the driver’s license was from SC and the rx already had a backtag from another store on it. No notes were written on it, but it was from one of the docs in FL. We told the people we couldn’t fill it. They left. Our store has since seen maybe about 15 or so. I am just amazed or maybe still a little naive that someone would drive so far for something like this.


  15. By Kat, December 5, 2011 @ 11:07 am

    This is interesting to me because in my area (northern Indiana), CVS pharmacists are not even allowed access to INSPECT, Indiana’s statewide narcotic program. It would seem to me that the adage of “keep your friends close, your enemies closer” might apply here. If CVS has that much confidence in its list of these pill mills, then they have the resources for the DEA to perform successful sting operations and catch many of these guys with their pants down. Let’s be smart about this here, guys.


  16. By FloridaPharmacist, December 6, 2011 @ 4:11 pm

    I agree completely with oldrphbs: “It should only be up to the Pharmacist to make those decisions as a matter of principle. It is a slippery slope and CVS has already taken too many decisions from the Pharmacist.”
    The suits in management seem to forget that pharmacists are trained health professionals! If a pharmacist, based on his/her professional judgment, believes that a prescription is not appropriate, then WE have the professional responsibility to take action. This includes contacting the physician, speaking with the patient, and sometimes refusing to fill the prescription. Non-pharmacist managment should NOT take it upon themselves to make these decisions FOR us!


  17. By johnnyg, December 6, 2011 @ 10:39 pm

    I just wish they would have made their list public….its not right to find out after the fact that i cant fill my meds. I recently moved and had to find a new dr. guess i chose the wrong one, because now i cant fill my script. If I had known there was a issue with this dr I would have went someware else.


  18. By dannyL, December 9, 2011 @ 4:09 pm

    I agree that this is an issue that should be decided by the individual pharmacist, not the drug store chain. These doctors are licensed by the state and have valid DEA numbers permitting them to write C-II prescriptions. If anyone is going to take a limiting action against them, it should be the state board of medicine or the DEA – not the drug store chain.

    Since CVS refuses to identify the physician, or the standards that were applied to justify the refusal, the consumer is totally defenseless. How does one possibly choose a doctor and have any faith that he/she will not be placed on the ‘blacklist’ in the future?

    Florida has to step in and stop this arbitrary abuse of self-implied power by CVS.


  19. By Shocked Patient, August 22, 2012 @ 12:45 am

    I learned that a pharmacist may refuse to fill in a prescription only recently. This is so absurd that such a possibility never crossed my mind. Of course, I was aware about the cases of refusing to fill in prescriptions for contraceptives, but had an impression that all these cases are resulting from religious fundamentalism going out of control. Now, after the news reported the Florida story, I learned that this is a sort of accepted practice, hardly regulated. Why do pharmacists believe that they can make any reasonable decision about needs of any patient? Do they know any patient better than her or his doctor? No. Do they know what medications are more effective for her or him? No.

    Why you assuming that you are able to do the job of the DEA? Do you have any special training in drug enforcement? Are you a former drug enforcement agent? People like you had left a lot of people in Florida in severe pain. Do you have any compassion? Any conscience?

    In your post, you completely misrepresented the CVS/Caremark story in Florida. CVS pharmacies are under investigation by the Drug Enforcement Administration at least since 2010 for ordering huge amounts of Oxycodone, sufficient for almost 10 times bigger population. Being caught, CVS stopped to dispense painkillers completely. It is not the first time when CVS was caught. It seems that fraud and deception are included in CVS/Caremark internal rules. It is actually the worst business I ever had to deal with.

    I am sorry, but your profession is obsolete and survives only because you and your fellows managed to stay in the way of the technological progress. Everything what a pharmacist is doing in a pharmacy, is either can be done faster and cheaper by computers, or is an overstepping limits of the pharmacists competence, like assuming the role of a minister of a religion (a pharmacy is not a proper place to preach anyhow), a medical doctor, a drug enforcement agent, and who knows what other roles you will invent to justify your paycheck.


  20. By Oxy Cotton, August 22, 2012 @ 9:54 pm

    Shocked Patient,

    You are an idiot. Pharmacists often know more about the drugs being prescribed than the MDs do. If you feel the profession is obsolete, make sure you tell the people behind the counter that next time you’re sick and stop into the pharmacy.


  21. By Obsolete, August 22, 2012 @ 10:42 pm

    Awe….Shocked patient is just mad that it might become hard to get narcs


  22. By Michael, August 22, 2012 @ 11:02 pm

    SP- Pharmacists not only can, but must refuse to fill illegal prescriptions because of the legal doctrine of corresponding liability. We are just as responsible as the doctor who wrote it.


  23. By Miss Obsolete, August 23, 2012 @ 12:46 am

    What a moronic statement! Most of the time the pharmacists are the ones that catch the mistake of the MD…so next time you see a pharmacist you can tell them thank you for doing what you do! Believe it or not we do serve a huge deal in monitoring the medication a person is on and making sure the the medication the doctor prescribes is appropriate for the person and written correctly. Second you go ahead and let a computer fill your scripts and see how quickly something fatal would happen. I know it might be hard to accept the fact that you won’t be able to get your narcs…unreal! Maybe its your view on thing that is obsolete not the job of a pharmacist!


  24. By Shocked Patient, August 23, 2012 @ 12:50 am

    To Obsolete:

    How deep and well argued are your replies! Do you expect to gain more respect for your profession in this way?

    To Michael:

    Illegal, of course. I am taking about the legal ones.

    And there is a little problem: pharmacists have neither training, nor experience of the drug enforcement agents. They cannot reliably determine which prescriptions are legal, and which are not.

    According to the news reports, they do not even tried anything like this in Florida. And, in fact, DEA discovered two years ago and is investigating now CVS/Caremark pharmacies in Florida for ordering 10 times more painkillers than normally needed. After being caught, they deny prescriptions to everybody.


  25. By PharmStud, August 23, 2012 @ 1:49 am

    Shocked patient,
    You’re an ignorant piece of shit. On average, an MD knows enough information about approximately 20 drugs that are the most pertinent to their practice. In school, they get about a 1 semester class on pharmacology. The pharmacist, on the other hand, is educated on hundreds of drugs of many different types, so yes, we do know more about the drugs than the doctors prescribing them. I’m not discounting the possibility that you are trolling us, given your shit grammar, but if you think pharmacists are obsolete, you’ve clearly never worked in healthcare and have no idea how the system works.


  26. By Brian, August 23, 2012 @ 2:31 am

    I am in pain management and take somewhat high doses of opiates and I’m from NY so this doesn’t affect me whatsoever but I have to say shocked patient is a moron and is clearly in withdrawal while writing his post. My pharmacist is a great guy and extremely knowledgeable why should he risk everything he has for a junkie to make what 25$ on a months script??? Use your brain at least what’s left of it


  27. By SeRPh, August 23, 2012 @ 9:08 am

    Shocked, Google the Asheville Project. Your ill-informed opinions on our profession is refuted. Pharmacists provide value to patients and generate improved outcomes when allowed to properly practice.

    And yes, I am very good at spotting forged prescriptions. Even without DEA training. I would, in fact, put my skills against a DEA agent any day of the week in that regard. I’m not sure what training you think DEA agents get in detecting fraudulent prescriptions?


  28. By Shocked Patient, August 23, 2012 @ 9:15 am

    To PharmStud:

    So, you have to take a lot classes. I am sorry for you; most of university classes are pure waste of time. But let us assume for the sake of argument that you know by heart the whole manual. How are you going to use this knowledge without ever seeing the patient? Let us assume even that you are right and a MD knows only about 20 medications (this is completely wrong, of course). Then MD prescribes only these 20 to all his/her patients, and how are you going to apply your knowledge of hundreds even if the patient visits your pharmacy (he/she does not need to)?

    You pretend to be an educated person. Anyhow, it is clear that you are literate. I call myself a patient, not a healthcare worker. Of course, I never worked in healthcare. But it is not a big deal to know that the system is not working and needs to be fixed. This is why it is being reformed now. I hope that you aware of this. One place where a lot of money is wasted was overlooked, namely your profession. And, of course, I know what services were provided to me, my family, my friends, etc. by pharmacists. Pharmacists check with the insurance how much it is going to pay and count pills. That’s all. It is going to be a pretty dull job for you with all your fancy education.

    To Brian:

    You know, after an ad hominem attack you lose all credibility. You know nothing about me. If you cannot argue without inventing stories about me, you have no arguments at all.

    Also, it is worthwhile to note that you demonstrated a complete lack of compassion. You live in NY, so you don’t care about Florida. You will wait until YOU will be denied your painkillers. Perhaps, then we will read YOUR story in the news.


  29. By PharmStud, August 23, 2012 @ 11:44 am

    Ah, so you’re choosing to go with being an idiot AND refusing to listen to people that know more than you. It won’t get you far in life, but at least you’ve found your home on the internet. There are, in fact, pharmacists that work OUTSIDE of retail pharmacy, and i’m sure you’d be surprised to find out that some of those jobs don’t involve talking to insurance companies OR counting pills. How do they justify giving us jobs that don’t involve counting by 5s or talking to the insurance company? can you believe that? But the fact that you’re choosing to attack the pharmacy profession on a blog post about not giving C2 drugs to people with fake scripts makes me suspect there is a lot you don’t understand about a great many things.


  30. By Pharmaciststeve, August 23, 2012 @ 12:00 pm

    @shocked patient… first of all you apparently do not understand the real job of the DEA.. and that is TO ARREST PEOPLE WHO ABUSE/DIVERT/SELL LEGAL AND ILLEGAL DRUGS. If you are a legit chronic pain patient and all this BS with the DEA in FLorida and other states are interfering with you getting your need meds.. you have my sympathy for having to suffer needlessly.. IMO.. the DEA policies are causing a lot of people to suffer.

    If on the other hand… you are a addict .. that can’t get their “drugs”… TOUGH SHIT !


  31. By Pharmacy Thoughts, August 23, 2012 @ 1:48 pm

    Shocked Patient,

    If you think pharmacists are obsolete, try doing without them. Imagine pharmacies were all shut down because pharmacists were deemed no longer necessary. Now, you either have to depend on a hospital or a physician for all of your medications. Good luck. It would not only take a lot longer, but it would cost a lot more too.

    For the record, I hardly ever count pills at work. I only count narcotic pills. I also almost never deal with the insurance companies. My technicians do most of the grunt work. I go through every prescription that we fill during my shift to make sure nothing is wrong with it. I also answer questions that people have about their medications, prescription and OTC alike. I give my advice on whether or not their problems deem a visit to the physician or the ER. I have literally saved people’s lives (meaning they would have died had I not intervened). I am more than the robot you think pharmacists are. I come home every work day having positively affected another person’s life.

    Do yourself a favor and think before posting comments like your initial one on a pharmacist blog in the future. You know you will automatically get swarmed with negative responses, both thought out and otherwise. If you feel strongly about the issue, that’s fine. That’s your opinion, and you are allowed to have it. But, don’t discredit our entire profession based on those opinions, especially when you do not work in the healthcare field. Pharmacists have an essential role in the field of healthcare, whether you believe it or not.

    -Pharmacy Thoughts


  32. By Shocked Patient, August 23, 2012 @ 9:42 pm

    Dear pharmacists,

    I do appreciate your replies a lot. It is always better to talk to people directly than rely only on third-hand information. Internet is a great thing: such an exchange is hardly possible in the non-virtual world.

    Unfortunately, your replies are leading me from a shock to a total distrust to your profession. I see here arrogant overconfident people, not hesitating to assume that somebody holding a different opinion is simply an idiot, drugs addict and who knows what else. And nobody said any word of compassion to people suffering in Florida because of CVS/Caremark policies and, apparently, crimes. Nobody provided any serious arguments refuting me.


  33. By Shocked Patient, August 23, 2012 @ 9:49 pm

    I wrote a detailed reply to all. But your system is not allowing me to post it, or parts of it, except the preceding comment. I do not like such games. If anybody is interested in my reply, please, post here a way to communicate it to you in such a way that it will be visible to everybody. If not, have a nice life.


  34. By Pharmacy Thoughts, August 25, 2012 @ 8:18 pm

    And, we see an arrogant patient who knows nothing of our profession, yet hates and distrusts every pharmacist out there, telling us we are useless. Saying things like that tends to lead to angry replies. If you were to tell anybody, anywhere, of any profession, that they are useless and obsolete, they would reply in heated manners as well.

    If you left out the last part of your initial comment, you may have found more responses based around the point of this blogger’s post and around the suffering of legitimate pain patients in FL. Instead, you chose to add something nasty based off no facts (just opinions) and received nasty things in return. Don’t dish out what you can’t take.


  35. By Brian, August 26, 2012 @ 11:30 pm



  36. By ian, June 3, 2015 @ 1:18 pm

    I am 63 years old and have degenerative arthritis. My doctor wrote a prescription for 30 10 mg. tablets of percocet. Two local cvs pharmacies refused to fill this. Furthermore, I believe they did so because of my longish hair – they didn’t like the way I look! This is just wrong. They are NOT doctors and should not be free to pick and choose whose scripts to fill. That’s not their job. Ten milligrams of percocet is not radioactive heroin.


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