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  1. baZING
    (Note: downloadable PDF and on-site link to Good Faith Dispensing Policy checklist available at bottom of the article for ease of access.)

    INDIANAPOLIS - 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 Marianne Ryan. "But I don't think it should be some big secret. This form had to be filed out by the pharmacist, so I think patients should know what's on it."

    Ryan is talking about what Walgreens calls its Good Faith Dispensing Policy checklist.

    The controversial checklist – and the policy behind it -- first came to light earlier this year after 13 Investigates reported many Walgreens customers are facing problems when trying to get prescription refills for pain medication.

    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. When WTHR contacted The Walgreen Company corporate headquarters for more information, the pharmacy chain declined to provide a copy of its GFD Policy, explaining it is for "internal use only."
    But after WTHR's investigations quickly spread across the Internet and more patients began speaking out, Ryan decided to leak the checklist to Eyewitness News to help educate consumers. A separate source provided WTHR with a copy of the full GFD Policy.

    "I don't think [Walgreens] will be happy about it, but when patients are denied prescriptions, they should know why," Ryan said. "And this is why."

    Confidential checklist exposed

    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.

    Patient impact

    Following the implementation of the checklist, some longtime Walgreens customers report long delays to get prescribed medication they desperately need to treat chronic pain.

    "I've gone there for years and it usually took just a few minutes to get my prescriptions, but now they say it could take up to five days," explained a Walgreens customer who suffers from a debilitating combination of multiple sclerosis, fibromyalgia and peripheral neuropathy. The customer said his last prescriptions for Oxycontin and Oxycodone took Walgreens three and a half days to fill, forcing him to run out of medication and resulting in terrible pain. At the customer's request, WTHR is not publishing his name to reduce his risk of prescription pill theft.

    Walgreens GFD Policy instructs pharmacy staff to "inform the patient that it may take additional time to process the prescription." Ryan says delays of more than 24 hours are unjustified.

    "It's ridiculous," said the pharmacy technician, who was required to use the checklist while working at Walgreens. "If you don't have other things going on, it can be done in ten minutes. On a busy day, it might take 45 minutes to an hour – but not three and half days. A lot of times, the pharmacy will say it's going to take a long time because we have to call your doctor, but calling the doctor is not part of the mandatory checklist. Calling the doctor is the optional part."

    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.

    An Indianapolis mother, prescribed pain pills because of painful blood clots in her legs, was recently turned away by a Walgreens pharmacist who refused to fill her prescription for Oxycodone. According to the patient, the pharmacist would not provide an explanation, other than to say he was following his company's Good Faith Dispensing Policy.

    "He said, 'We suggest you take it to CVS. At this point we're just feeding an addiction.' He was very loud and it was right in the open when he basically called me an addict. At that point, I was just so upset I left," said the customer, who requested anonymity to protect her family's safety. "I've been going to the same Walgreens for eight years. All I wanted was the same medication from the same doctor for the same medical condition, and they refused with no warning. It's very upsetting to be treated this way," she added.

    Walgreens fined $80 million

    Industry observers say Walgreen's decision to change its policy regarding the distribution of pain pills was borne out of necessity.

    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.

    "These retail pharmacies filled the prescriptions for addictive prescription narcotics despite obvious red flags that clearly indicated the prescriptions were illegitimate, and the drugs were likely to be diverted for street use," said U.S. Attorney Wilfredo Ferrer, culminating a year-long investigation by the US Drug Enforcement Agency.

    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.
    "Managers made it clear … we don't want the patients to be made aware this what we're doing," Ryan told 13 Investigates. "They never really explained why. I just figured we had to do it to give Walgreens cover because of what happened in Florida."

    Revealing a secret

    While the new policy came as a shock to many customers, it did not come as a surprise to Ryan.
    "Walgreens had to do something because the problem wasn't just in Florida. In our store, no prescriptions were ever being turned down," she said. "We had a reputation that we were the store that would ‘fill anything,' so we saw suspicious prescriptions all the time. Even when we'd raise flags, our pharmacy manager didn't care. He told us to fill them anyway."

    A senior certified lead technician with 15 years of pharmacy experience, Ryan worked for a Walgreens in suburban Philadelphia for 18 months. She left the company this summer to accept a job at another pharmacy, but not before witnessing the GFD Policy in action.

    She was not impressed.

    "Any good pharmacist asks a lot of those questions anyway," Ryan said. "By giving us a checklist, they want to be able to cover themselves by saying ‘We have this policy. We went through it. We did everything we possibly could to make sure this was a good prescription to fill.' But I saw very few things change when this came out, other than people were being inconvenienced… 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.

    Why did she contact WTHR to make the confidential checklist public?

    "I take these kinds of medications so I know what it's like to be in pain," said Ryan, who has chronic back pain caused by a herniated disc.

    To deal with that pain, Ryan takes several narcotics prescribed by her doctor. Based on Walgreen's new checklist, she worries her prescriptions for pain pills would raise enough red flags to be denied.

    "I've been taking these same pills for years, but they consider that a problem. And I just switched jobs. My insurance at my new company hasn't started yet so I'm paying cash for my prescriptions. With that, I could be turned down and they'd never tell me why. I just don't think that's right."

    Not what the doctor ordered

    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.

    "This is really outrageous," the patient advocate said after looking at the GFD checklist obtained by 13 Investigates. "It's simply wrong for people not to know they are being evaluated in this fashion. If Walgreens wants to really offend its customers and prescribing physicians, this is the way to do it: have a secret policy and force people to comply with it and not tell them what it is."

    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."

    Pain specialists tell Eyewitness News frustration is running high.

    Over the past several months, pain clinics in the Indianapolis area have observed a dramatic increase in complaints from patients who are having trouble getting their pain medication from Walgreens.
    "They feel like they are being treated like an addict and many of them have said 'I'm not going back to Walgreens. I've got to find another pharmacy to go to because they made me feel really bad.' We hear it every day from multiple patients," said Jackie Rowles, a certified registered nurse anesthetist at Meridian Pain Group in Carmel.

    Rowles says she supports any legitimate effort to improve patient safety, but she isn't sure Walgreen's new policy accomplishes that goal.

    "I think the intention is good, but there's a lot of unintended consequences from this. I think it puts the pharmacist in a very difficult situation," she said, adding that even simple questions on the GFD checklist often have very complicated answers.

    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."

    Fighting back

    While Rowles had not seen Walgreen's checklist until it was provided to her by 13 Investigates, she is very familiar with the issue.

    Rowles is a board member of the American Academy of Pain Management, and her organization has been tracking complaints involving Walgreen's new dispensing policy for several months.

    "We have lots of patients and a lot of doctors complaining, and we felt we had to have a way to communicate with the policy makers," she said.

    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 information in these reports will be communicated directly to Walgreens administration so that they may clear up misunderstandings and retrain their employees as needed," American Academy of Pain

    Management policy director Robert Twillman explained in a recent memo.

    The online form allows doctors and patients to submit a complaint without their identity being released to 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," wrote Dr. Steven Stack, an AMA spokesman and former board chairman. The AMA tells Eyewitness News the issue is now high on its priority list, and that the organization "will continue to work on a number of fronts to combat diversion and drug abuse while at the same time preserving patient access to medically necessary treatment for pain."

    Response from pharmacists

    The state organization that represents Indiana pharmacists declined to discuss Walgreens' Good Faith Dispensing Policy. "We really don't have anything to say or anyone for you to talk to," said Larry Sage, executive vice president of the Indiana Pharmacists Alliance. "We have no comment at this time."

    Individual pharmacists who spoke to WTHR (none of them wanted to be interviewed on camera or to be named in this story because they feared professional reprisal) offered a wide variety of reactions to the Walgreens policy. Some said a written checklist that provides clear instructions to curb prescription drug abuse is a positive and long-overdue development for both pharmacists and patients. Others were more skeptical, expressing disdain for a policy that was apparently adopted in reaction to pressure from federal regulators and that puts pharmacists in the cross hairs of angry patients and physicians.

    Few pharmacists were surprised that Walgreens implemented a new policy.

    "These medicines can be fatal and the government says they must be dispensed properly," said Bruce Clayton, associate dean at Butler University's College of Pharmacy.

    He said pharmacists must determine each prescription is medically necessary and appropriate before it is dispensed. Those who fill questionable prescriptions for pain pills without asking questions can face severe consequences.

    "If you're doing that, you are not following federal law and state law regarding controlled substances and if prosecuted, one can lose one's license over it. So the pharmacist really has no choice but to collect that info when the prescription is filled," Clayton explained.

    Many drug stores, however, do not require their pharmacists to perform patient background checks and to answer a long list of questions before filling a prescription for controlled pain medication.

    That may change, according to Clayton.

    "I think we'll see some growing pains as pharmacies try to reign in this problem with prescription drug abuse. A pharmacy does have to be really cautious and do its due diligence. I think we'll start seeing a lot more of that," he said.

    Walgreens has declined multiple requests for interviews from WTHR. Asked why the pharmacy chain instructed its pharmacists to keep the GFD checklist confidential, company spokesman Jim Graham wrote "in general we do not make any of our internal policy documents open to the public."
    While Walgreens would not provide Eyewitness News with a copy of its GFD Policy or checklist, it did send WTHR the following statement in July:

    "With the sharp rise in the abuse of prescription painkillers in recent years, health care professionals in all practices are continuously striving to find better ways of ensuring those medications are used only for legitimate medical purposes. We are working to ensure our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances. We have recently taken a number of steps to provide additional guidance and training to our pharmacies on the proper handling of controlled substances.

    "Because of the legal requirements placed on pharmacists to verify that controlled substance prescriptions are issued for a legitimate medical purpose, pharmacists may need to gather additional patient information from their prescribing physician's office. This diligence may take extra time. For example, under our good faith dispensing policy [sic], pharmacists may determine that they first need to check the state's Prescription Drug Monitoring Program database (called INSPECT in Indiana) for anything unusual. They may also decide to contact the prescribing doctor's office to verify the diagnosis and confirm that the patient has had a recent examination. Often, this information can be obtained from a member of the doctor's staff.

    "Our good faith dispensing policy is intended to be used consistently by our pharmacists for each individual prescription to determine whether the doctor's office needs to be contacted. Our policy does not require prescriber contact for every prescription. We firmly believe that addressing prescription drug abuse will require all parties – including leaders in the community, physicians, pharmacies, distributors and regulators – to play a role in finding practical solutions to combating abuse while balancing patient access to critical medication."

    By Bob Segall on Sept. 18, 2013
    http://www.wthr.com/story/23469086/...l-new-policy-on-pain-pills?Clienttype=generic


    (Note from BaZING: If you have personally had problems getting your pain prescription filled at Walgreens and wish to file a complaint, HERE IS A LINK to the online complaint form created by the American Academy of Pain Management that is mentioned in the article. If you would like to read more about this issue, many of the links in here were automatically pulled from this story, and redirect to other articles revolving around this problem.)

    edit: attached Good Faith Dispensing Policy checklist

    edit: ON SITE LINK to GFD Policy checklist

Comments

  1. Moving Pictures
    Walgreens is a bitch to get your meds filled at. They make you wait until the exact date they are do (every other pharamacy I've used will do it at least 1 if not more days ahead of time) plus the require you to show photo ID every single time you go to fill a script (narcotic). I've never filled an opiate 'script there but I had some benzo scripts that I got from the hospital and went straight to walgreens from the hospital but I didn't have my ID so they wouldn't fill them. Not to mention Walgreens is the most expensive pharmacy I've ever used. Walmart and Kroger have a $4 perscription plan, well I brought in my Prozac 'script thinking that it would be the same, it was 36 dollars for 30 pills. I said fuck that shit. And my clonazepam was 39.99 plus tax for 90 1 mg pills while at other places it was in the 20-30 dollar range.

    I'd don't use walgreens as my pharmacy since i don't have insurance.

    Funny thing though, Walgreens is great for buying pseudophed. I mean, you can't go over the limit but they never question you or eyeball you funny. They sell the cheap generic 60 mg 40 count time release pills (the best ones for meth making). They will not sell syringes though. Walmart on the other hand sucks for buying pseduo products because they only sell the 30 mg 30 count pills and all others are combination products, and have denied sale to me twice despite that fact that I was not over the limit. The woman just went and talked to the pharmacist and came back and said, we can't sell these to you. I said why and she said the pharmacist declined sale to you. I knew it was pointless to argue. But I've bought rigs from Walmart like a dozen times and never had a problem. They sell them to me easy as pie.

    Pharmacies are weird...
  2. Basoodler
    Other places have had lists of dr's or clinics they absolutely will not fill.. thats has been going on for almost a decade in south central ohio and WV.. if a pill mill was around for long enough people would run into a situation where they had to drive 50 miles to fill the script.. even then the person may run into problems because the phamacists marked the script in such a way that it would alert others.. those marks accumulate if you are refused several places

    That would include walgreens, cvs,rite aid, walmart and grocery stores..hell the mom and pop pharmacies even stopped..
  3. baZING
    Well sure, Basoodler, but that's entirely different. A pill mill, by definition, is filled with people trying to defraud the system... and a few who might be legit. Did you read some of those "additional questions"? Apparently, under the "Good Faith Dispensing" system, the only people who AREN'T suspicious are those who do not have a new prescription (But also haven't been on it for more than six months!), have not recently changed medication even for legitimate reasons, have a doctor nearby, have insurance, have a prescription of 120 pills or less, and isn't filling it one second too soon. And even if you DO meet these requirements, it hardly sounds like getting your Rx on time is a guarantee.

    Refusing to fill prescriptions that come from a known pill mill is one thing. This takes it to a whole new level.
  4. jakemoe
    Walgreen's enables the DEA big time. They are the DEA's obedient poster child of pharmacies especially when it comes to attitude. I have never felt welcome or respected at a walgreens.
  5. Basoodler
    Isnt there an ongoing government investigation about the informatipn presented in the 90's stating that opiates had low addiction potential..

    What im getting at is walgreens, rite aid and cvs are probably the most agressive corperations in the USA when it comes to securing long term profit.. all three will drop millions of dollars to buy up prime locations for their stores
    they will even pay for property to block competition..

    Walgreens enables the DEA?

    They were popped for enabling pill mills in florida not long ago. Those news stories are posted here

    Walgreens to pay 80 million in fines -- june 12 2013

    I think what you are seeing are changes in the industry.. not walgeens specifically. I would expect more of the same elsewhere.

    Check out google news results http://www.google.com/search?q=chro...YDYCA&ved=0CAoQ_AUoAA&biw=320&bih=462&dpr=1.5

    There is nothing positive, infact natural opiates are inder attack for causing back pain
  6. baZING
    Yes Basoodler as far as I know there is indeed a government investigation into those claims made in the 90s. However, this was not really a general problem with Pharma but rather completely specific to Purdue and OxyContin, IIRC. They were the ones claiming that in extended form, oxycodone has low abuse potential, and engaging in super inappropriate marketing for a SII controlled substance (for example, OxyContin frisbees).

    I'm not sure I agree that we're seeing a change in the industry, at least to the extreme that Walgreens is taking it, but of course the only way to know is to wait and see. I have not experienced any of these kinds of problems at CVS (and I just filled my most recent script Thursday) so at the very least it seems that other retailers have either not yet implemented such a strict policy, or otherwise I'm not that suspicious (?).

    The thing is, reading the article, in a way it sounds like Walgreens are deliberately trying to make it so difficult that a large amount of their patients will go elsewhere. I'm stating the obvious here, but CVS (for example) hasn't recently been fined 80 Million dollars and seems perfectly OK with accepting Walgreens' rejects. I really feel like this is largely an exercise in keeping opioid users (including therapeutic) away from their business, lest they fuck up again and lose another $80 million.
  7. Basoodler
    Do you honestly blame walgreens? 80 mil is a lot of scipts.. they also lost a disto center. All for a pain management industry that has already been pre judged as criminal.

    They like every other big box pharmacy operates within the confines of the fda/dea and federal law.. so nobody really is more or leaa in the pocket of the dea.. pain management with opiates is about to be shrunk world wide.. those lost customers do not present much of a future risk.. its not worh dicking with
  8. baZING
    I do blame Walgreens, if only for their dishonesty in this whole thing. Clearly no laws have actually come into play yet; by all accounts this does not appear to be a direction from the DEA, but rather a choice made by the Walgreens company in order to be compliant.

    Or perhaps it is a direct order from the DEA, but if that's the case then it is only Walgreens thus far. If it were actually a blanket law, every pharmacy would have to be doing this, and there's no evidence to suggest that's the case. Even if one wanted to argue that we couldn't know if other pharmacies are doing this, because it's "secret," there have not been any large amounts of complaints coming out from other big chains.

    This was a decision made my Walgreens after they made a huge mistake. They had the opportunity to inform their patients that this policy was being implemented, and chose not to make that information public. In turn, they left people without medication, in pain and in withdrawal for days with no information as to why that was.

    So... yeah. I do blame Walgreens, at least for all that. And I don't think that's misguided.
  9. Basoodler
    Do you honestly blame walgreens? 80 mil is a lot of scipts.. they also lost a disto center. All for a pain management industry that has already been pre judged as criminal.

    They like every other big box pharmacy operates within the confines of the fda/dea and federal law.. so nobody really is more or less in the pocket of the dea.. pain management with opiates is about to be shrunk world wide.. those lost customers do not present much of a future risk.. its not worh dicking with

    If you dont think the industry will follow its largest chain, you are wishful thinking. Because the enviornment has changed.. chronic pain scripts can go from legal to illegal at the drop of a hat.. because if the doctor is posecuted for writing scripts, the feds will nail the pharmacy who filled them

    Legal highs get better press lately

    This is nothing more than smart business. Getting out of the way of the way of the fork that is about to be jabbed into that market
  10. scartissue_68

    This makes no sense. In Indiana, docs are required to write a new script every time for any Schedule II medication. This includes all the opiates listed above in the article. No refills. No future dated scripts. Nefarious docs who might use patients to divert opiates into the black market, wouldn't be so stupid as to use the same pharmacies, ordering Schedule II drugs that are obviously being filled sooner and for a higher volume than would be normal.

    If there's diversion, it's at the distribution or retail level, directly from the Pharmacy. I've had similar experiences with odd delays at CVS, so I switched to a locally owned shop that only sells drugs. No problems in the past 6 months.

    Yes, I live in Indiana.
  11. baZING
    I'm really not sure what's not making sense to you about that quote, or why you're making the assumption that diversion is largely happening at the distribution level rather than at the level of the consumer. What you described about schedule II 'scripts in Indiana is standard practice in practically every state (if not all of them) and not unique to yours; schedule IIs are almost invariably required to be a new prescription, brought to the pharmacy, that is not future dated. But how do any of these things stops people from selling their medication? Even UAs at pain clinics only go so far, as someone could conceivably simply sell all but what was needed to pass a screen.

    I also am not sure what "nefarious doctors" have to do with it. I mean, yes, of course there are corrupt health care professionals who may be engaging in such activity but I would think that most patients who sell their meds are not doing so under the direction of their doctor. There are people who are prescribed opioid medications who never need them and sell them, who need them once but the pain goes away and they continue requesting the script and sell them, and people who are in pain but would rather have the money. I was under the impression that this is where most diverted prescriptions come from, rather than being (willingly) distributed so high up. I have only seen a few isolated incidents of large-scale diversion at the levels you suggest, and most of them had to do with Florida pill mills. Have you seen anything lately about diversion at the distribution level?

    Mostly as an aside, I'm pretty sure that going to different pharmacies would be the worst thing a person intent on diverting medication could do. Almost all pain clinics require that people go to the same pharmacy (or at least, change infrequently and with good reason), so I would think that hopping around would not be the best way to remain inconspicuous?

    I'm not trying to be a curmudgeon, I am just honestly a little confused. I'm sort of in a medication haze today, so my apologies if I sound like I'm just being combative. I'm having trouble digesting information ATM.
  12. Basoodler
    To clearify my veiw of the market.. and why in this case the customer doesnt matter

    I think the problematic and confusing part of this issue is there are no clear guidlines when it comes to what constitutes a crime and who is punished.

    The doctors have this blurred line of what is and what isnt lawful treatment for patients
    .. now they can be investigated if one of the many people/agencies decide he/she is putting patientsat risk for addiction or if they decide they are writing too many scripts.. which seems to vary greatly

    The pharmacies are for whatever reason charged with monitoring doctors and making judgement calls on what to fill and what to refuse. They will be punished for filling legal scripts if the doctor gets in trouble. Or if they dont follow the ever changing label/dispensing guidelines .. every single medication has its pwn guidelines

    The fda and dea have made several changes on the guidelines that parmacies are to follow

    For example:


    The rule/lable changes must be followed by both the dr. And pharmacy.. so everytime things change it has to be passed on to pharmacists and techs quickly and successfully to avoid trouble.

    Which means paying pharmacists overtime in a lot of cases to attend meetings.. tha is upwards of $70-100 dollars an hour conservatively.

    I dont know if any of you are familiar with pharmacists enough to understand that the return on investment of those meetings isnt good. The job market for pharmacists is so tight that there isnt much quality control. You have mostly good ones but mixed in to them are people who probably are not fit to work at gas stations and others who seem to reside in another reality.

    The liabilty has increased to the point that places like Walgreens no longer want the chronic pain patients or doctors unless they walk a fine line.
  13. jakemoe
    I'm speaking of my experiences when I say they enable the DEA. I also should've said they go out of their way to cooperate with the dea. I've been questioned and my doctors have been questioned about my prescriptions by the pharmacist. Very annoying and I do all that I can to avoid them.
  14. prescriptionperil
    At my chronic pain center, the nurse told me Walgreens was calling asking for each patient's specific diagnosis. I don't use Walgreens, but wouldn't this practice be a violation of Hippa laws. I have more than enough documentation, but this is getting ridiculous. Checking a state data base should eliminate most doctor shopping. My pharmacist stated he sees many forged scripts daily. According to him they're easily recoginized. My scripts are computer generated making tampering difficult.
    Two of the pain management employees were stealing scripts from the office.

    Six months on the medication arousing suspicion in chronic patients is ludicrous. DUH, that's why it's called chronic.
  15. prescriptionperil
    I do get my Schedule 2 Focalin XR scripts post dated. For awhile I had to pick it up monthly, but since
    my psychiatrist found out pediatricians were post dating, he began the process unconsequentially.
    Opiates seem another matter.

    So, so, sick of chronic pain.
  16. Basoodler
    pharmacies normally confirm c2 scripts with the Dr. periodically.. especially the first few times.. that covers their ass. that isn't just with pain meds or c2 scripts.

    competitor pharmacies are also good about communicating with each other about issues like smurfing, odd or suspicious scripts and sketchy doctors.

    if a Dr. is viewed as suspect the pharmacies will always call them and may nor fill the script. when the pharmacies talk they can pinpoint patterns..

    its not conspiracy
  17. AKA_freckles
    Fuck walgreens. Off topic, but they tried to charge me almost $300 for generic seroquel. Are you fucking kidding me? I then got it filled for $15 at costco. Never again, WAGS. They were also the pharmacy that popped a perfectly good doc in our area. he had to pay almost $70,000 and reapply for his DEA dispensing number. assholes.
  18. Billybarry
    Well this thread was very informative. I think a friend of mine seriously screwed himself. He's not too bright, so I'm not surprised, but his usual Walgreens he goes to was telling him they didn't have enough of the 10/325's he's prescribed on refill date. So, he tried to go to some other Walgreens. After 3 or more different ones they finally gave him some. I actually drove him to the pharmacy to get them when they were ready and we went thru the drive thru. That was probably a mistake. His dumb ass didn't even have the $1.50 he needed to pay for it, so I had to break out the money with the pharmacist looking at us the whole time with an unfriendly stare the whole time. I knew it didn't feel right, haha. Now he goes back to get his script this month and similar crap, they give him the run around at a few of them, and then they tell him he's blocked. He then goes to a CVS and they claim they don't have enough. He finally text me the other day, that a pharmacy I believe either at a hospital or next to it will fill it, but not Until January. They're saying that since he has several other meds, and their refill date is January whatever, that they'll be willing to do the Hydro's at the same time as those. I find that kind of weird, but what do I know. Hope he'll be ok. We're talking another week and a half till he gets those. Doesn't make any sense since it's all legit. His only crime is being an idiot. I'm sure he probably said something stupid to the pharmacist to piss them off. The whole drive thru thing seemed weird as well, at least to me.
  19. Canuckfan
    We get trammies at Wall Greens and quite often they get skiddish about how many we are supposed to get and if we can refill it a lousy 2 days beforehand.

    Here in Florida trammies are now controlled so the hoops have increased.
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