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Pharmacy Panel Addresses Patient Problems

Oct 6, 2015
Originally published on October 6, 2015 8:56 am

Acknowledging that it isn't a "magic button," a Florida Board of Pharmacy committee on Monday gave preliminary approval to an attempt at curbing the "pharmacy crawl" forced on patients who can't get their pain medications filled.

The Controlled Substances Standards Committee unanimously approved the proposed rule change after hearing emotional testimony from patients, pharmacists and doctors over the past few months.

Monday's meeting in Tampa was no different.

When his turn to speak arrived, a furious Louis Taddia threw down a Ziploc baggie with a prescription in it.

Pointing to the bag, Taddia told the panel that, 10 days after dropping it off at a local chain drug store where he's been doing business for three decades, he was informed that his prescription for Percodan had been rejected.

The pharmacist decided Taddia needed to be on a time-released medication instead, the Carrollwood retiree said.

"What works for me is what my doctor gives to me," he said. "This is not fair, what you people are doing. ... You push me and the rest of us out into the street to try and get our medication. It's not fair. It's not right. And it's unconstitutional."

Taddia continued to rant after he returned to his seat, repeatedly interrupting committee chairman Gavin Meshad.

"This committee is not on trial here," Meshad said, while acknowledging the frustration of those like Taddia, caught in the cross hairs of a state and national crackdown on prescription pill abuse that's resulted in patients with cancer, chronic pain and other illnesses routinely having their prescriptions declined.

That has led to patients sometimes traveling to more than a dozen pharmacies in a frustrating quest for pain medications. The "pharmacy crawl" has also impacted patients who receive non-opiod drugs.

"I know everybody's got a personal experience. We've heard this. We've heard hours and hours of it. We've taken what you've said and we've created a committee to start moving action. ... The issue is bigger than being able to solve this today. The feeling was, let's do something," Meshad said.

Pharmacists pin the blame on the U.S. Drug Enforcement Agency. Doctors accuse pharmacists of ignoring physicians' orders. The DEA points the finger at distributors. Some pharmacists lay the onus on corporations whose policies include "red flags" that prohibit the health professionals from providing medication for legitimate patients.

The full pharmacy board is scheduled to vote on the proposed rule change Wednesday. The revamp would flip the rule from its current focus on detecting fraudulent prescriptions to ensuring that legitimate patients get the drugs they need.

The change would also require pharmacists to take a two-hour course on the "Validation of Prescriptions for Controlled Substances," that will educate pharmacists about ensuring access to narcotics for "all patients with a valid prescription."

"I think the educational program is going to help a lot, because I do believe that pharmacists have been using the old rule as a rule to turn people around without truly assessing a legitimate prescription," said Florida Board of Pharmacy Chairwoman Michele Weizer. "This education is going to help them to look at the patient as a whole and really give them individualized care. This (pain) therapy is not the same for every patient. ... You can't treat them all the same."

And the proposed rule also makes clear that "neither a person nor a licensee shall interfere with the independent professional judgment of the pharmacist who is responsible for determining that the prescription is valid."

While the new rule won't force corporations like Walgreens --- which paid an historic $80 million fine related to dispensing of highly addictive narcotics --- and CVS to change their policies and procedures, it may give pharmacists comfort, said Florida Pharmacy Association executive vice president and CEO Michael Jackson, who helped craft the 2002 regulation now under the microscope.

"I think that's beneficial. I think that supersedes what a corporate policy says," Jackson said after the meeting. "And it sends a message to pharmacists that when you hang your shingle on the wall, yes, it's appropriate that you should follow procedures of the pharmacy owner, but ultimately if something goes wrong, you have to know that you're the one that's going to have to sit here in front of this tribunal."

It could be months before the new rule goes into effect, and it won't have any impact on the amount of highly addictive narcotics that pharmacies can order from distributors. Many suppliers have cut back on orders of controlled substances because of DEA scrutiny, said Cardinal Health executive Gary Cacciatore.

In a 2012 settlement agreement, Cardinal Health --- one of the country's largest distributors --- was banned from shipping and selling narcotics from its Lakeland facility for two years. Cardinal Health does limit its customers' orders for controlled substances, Cacciatore said.

"I don't really know how that's going to change unless we get some further guidance from the DEA, which seems reluctant to do that," Cacciatore, the company's vice president of regulatory affairs, said.

Meanwhile, patients like Dawn Weiher are left in tears.

Weiher, who is being treated for chronic pain, said she ran out of her pain medication five days ago after a pharmacist refused to fill her prescription.

"I have anxiety disorders and panic disorders. So I start getting a little upset when I don't have my pain medication," Weiher said. "I'm not a drug pusher. I need it to survive. And I'm being treated like a criminal."