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