Locals in need of prescription medications being turned away " article - Las Vegas

Been hearing FL patients comment on not being able to get meds..
this is NV - with a mention of FL -
but CVS and Walgreens are both mentioned & their responses quoted


http://www.jrn.com/ktnv/news/contact-13/contact-13-investigates/Locals-in-need-of-prescription-medications-being-turned-away-240035271.html?utm_source=Aptivada&utm_medium=email&utm_campaign=BreakingNewsKTNV&lc=Tablet

" ...CREATED Jan. 13, 2014
Las Vegas, NV (KTNV) -- Imagine going to the pharmacy to fill a prescription, only to be turned away, denied medication both you and your doctor know you need.

That's what's happening to patients across the area.

Patricia Kellner suffers from osteoporosis, spinal splinters and degenerative disc disease, "It's excruciating at times. I've had nerve blocks also and that's when it gets to the point where I'm totally immobilized."

Patricia's doctor, Mahesh Kuthuru, prescribes heavy duty meds for her pain but lately it's harder for her to get those prescriptions filled.

Chief Investigator Darcy Spears asked, "Do you feel like they're questioning you, suspicious that you are abusing? Selling?"

Patricia answered, "Yes. Yes. Yes."

Abuse of prescription painkillers, particularly oxycodone, is a serious problem, leaving real patients with real needs battling someone else's addiction.

Desert Pain Management sees between 300 and 500 patients a month and Dr. Kuthuru reports at least half of them have problems getting legitimate prescriptions filled.

"A lot of them are elderly. They are handicapped. They have complex medical conditions," said Dr. Kuthuru.

It's not just Dr. Kuthuru's patients who've run into roadblocks at local pharmacies.

"Before the surgery on my feet, you get up in the morning and it's just unbearable."


A patient named Tami suffers from rheumatoid arthritis. She had no problems filling her prescriptions for oxycodone at Walgreens and CVS over the last few years. Now? Delays and denials at both.

"You get the, "No, we're not going to fill it.' Well, why not? 'Well, you don't meet our criteria.'"


So what's changed?
In an effort to crack down on prescription drug abuse, the U.S. Drug Enforcement Agency slapped Walgreens with $80 million in penalties last summer over violations at a distribution center and retail stores in Florida. In 2012, the feds pulled licenses to sell controlled substances from two Florida CVS stores.

Why would that affect Nevada patients? Our state board of pharmacy believes those large corporations have tightened procedures nationwide.

"But to just say no? And no reason? No excuse. No explanation. No nothing. You just get turned away," said Tami.

CVS sent us this statement:

"Federal law places a corresponding responsibility upon the pharmacist to ensure that a prescription for a controlled substance is issued for a legitimate medical purpose. If a pharmacist knows, or has reason to believe, that a controlled substance prescription is not issued for a legitimate medical purpose they cannot legally fill the prescription. Our pharmacists consider a variety of factors when evaluating a controlled substance prescriptions as part of their corresponding responsibility obligation. These factors are taken into consideration when pharmacists exercise their professional judgment in determining the appropriateness of filling prescriptions for controlled substances."

And CVS sent an additional statement when we asked about the federal law enforcement activity in 2012:

"We previously responded to the DEA’s concerns by enhancing our policies and procedures for filling controlled substance prescriptions. We believe these changes further support our pharmacists as they exercise their professional judgment to ensure that prescriptions they fill have been issued for legitimate medical purposes."


Dr. Kuthuru believes that could cross the line into pharmacies practicing medicine.

"I disagree with the pharmacies making decisions on behalf of the patients or on behalf of the doctors."

Walgreens sent this response:

"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 over recent months 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, pharmacists may determine that they first need to check the state's Prescription Drug Monitoring Program database 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.

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."

And Walgreens added the following information after we asked about the federal law enforcement activity in Florida.

"Our agreement with the DEA provided us direction going forward on specific measures the DEA wanted to see enacted and clarified compliance steps moving forward. In fact, we had already taken many of those measures before the agreement was announced.

While I can’t comment on specific doctors or detailed procedures, I can tell you as I mentioned earlier that under our good faith dispensing policy, pharmacists may determine that they first need to check the state's Prescription Drug Monitoring Program database 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."

For patients like Tami that means running all over town.

Last month she says she went to nearly 10 pharmacies to fill her prescriptions.

The problem has gotten so bad Dr. Kuthuru is asking lawmakers for help. The state's advice to patients who are denied? Try another pharmacy or talk to their doctors about pain management alternatives. ... "

IMHO it should not be the pharmacists job to decide if any medication is needed nor should they be held accountable. This is something that is between a doctor and the patient and if either one is writing or abusing the medications then these are the people the gov't need to go after.

What caught my eye was "legitimate purposes." There is absolutely no way for any pharmacist to make that determination, nor should they be given the power to do so.

I respect their knowledge with regards to protecting and safeguarding us from potential interactions, but when they start making determinations about what they personally feel is "legitimate use" of ANY medication, and they're given the power to override a physician, they are practicing medicine without a license.



M.

A big red flag here I think is look at how many patients this dr is seeing a month. How can he possibly render good medical care seeing that many patients a month. That would really scare me & makes me think this guy walks in & does nothing but write scripts because that is all he has time for. He is not spending any time doing exams on his patients.

Just my 2 cents.

Every pharmacy in my area of Florida has a Dr list that's graded, Drs they fill for without hoopla, Drs they may fill for after checking a few things and Drs they will Not fill anything for from anyone!

They don't get bad grading by being upstanding, board certified and legitimate pain Drs! They get the bad grading by seeing too many patients, not seeing the patient every 60days,blatantly not entering dx codes as they've been asked too, either on the script or via paperwork the pharmacy has sent them, consistently overprescribing above recommended daily doses, or having had sanctions levees against their controlled prescribing privilege past or present.

Patients are flagged or graded primarily the same way. Have you jumped around changing pharmacys, have consistently attempted to fill early, have you changed Drs frequently, do you show up at the ER as alternative PM? And with prescription monitoring all narcotics are entered! Not just what you fill! If the ER gives you a shot of demerol, its there, if your oral surgeon uses morphine post-op, its there, if your in a methadone or suboxone clinic, its there?

See where some of these patients that say "I've done nothing "to warrant this treatment may have actually and not even realized it or thought about it?

Taking a bunch of ppl with you to fill your meds can get you a flag by an overzealous tech or RPH! Having ppl waiting in a car in the parking lot? Yes again! Filling a script at 5 minutes after midnight the day it's due looks suspicious too some RPHs.

Just saying, you've got to have the whole picture before you really know what's happening here.

No offense taken, I've been in this field a long time and I'm not saying everyone but they only gave 2 examples.

Let's break it down maybe?

We will even go so far to say this Drs above and beyond most and works 5 days a week, 8-9 hours in office and only bows out for 30 minutes at lunch? Assuming there's no holidays and he's out more.

Seeing 500 pts in a month and required by most insurance and Medicaid/Medicare rules for new patient payment he has to give them 30-45 minutes? Returning patients can get by with 15 mins but how many want that? Month after month?

How many patients can he possibly squeeze in those 20 8-9 hour days having 500? From my math someone is getting royally beamed out of their 15 mins or worse new patients are getting meds written without proper physicals or history? Mind you I'm guessing he's still billing for the same amount if he's spending 5 mins instead of 15.

Thats enough to make anyone wonder about the kind of Dr he is. It doesn't you?

Move to surgeons and they are in surgery at least one of those days a week, and lose some of their office hours making rounds right?

I dont know any Dr that works 7 days a week.

The numbers just don't mesh for me, sorry!

Well that's not making sense? If everyone got the same amount of time they wouldn't be able to see 10 patients a day? A new patients not going to require the same amount of time an established patient coming in to pick up scripts? A patient with staples to come out for instance is going to take more time right?

Well how can a Dr who see's 500 give you or any of them more then 3-5 minutes once in those 20 office days?

I'm not sure what kind of Dr we're talking about but I've never encountered a Dr that could adequately see 500 patients a month when that consists of 20 or so days!

Urgent treatment doesn't even see that many without PAs and NPs taking part of them.

I don't want or need a Dr that pushes me in one door after waiting hours, hand me a hand full of scripts and shoves me out the other side!? That's not adequate patient care!

They're under no obligation to accept medicare or medicaid and if they do those folks should get the same time a private pay patient does!

Please correct me if I'm wrong, but,....is it possible that the "total time" being booked for is including the time you're ushered into an exam room,....seen by the MA,....then by the PA perhaps,....then the MD himself comes in for 10-15 minutes....

But all in all, you've been "in the exam room/treatment facility" for 45 minutes?

Plus, what about when you change into your little johnny and they run over to see the next patient and you're just waiting.

I don't think it's actual treatment time or one on one time with the doctor. I wonder if when, for example, we get our blood drawn, during that 3 minute time frame, are we billed for lab time AND lab draws?

I would assume, as Susie brought up, that any doctor that contracts with, be it Medicare, Medicaid, or any HMO, they sign an agreement that despite what they may bill, they will accept only what the insurance company pays. (I don't know if an HMO bills you the balance?)

My previous doctor, even on follow-ups, would bill for intermediate, not basic. Who am I to disagree in my 15 minute time frame, not 30 minute,....I'm just the patient.

I do not understand the cross-over and how when it's all added up, the time being billed cannot fit into one work day.

Just sayin'....and maybe blowing a little steam. I admit, I do not know the intricacies, so I'm sorta thinking out loud about the what if's.



M.