How can a pharmacist decide not to fill a valid prescription?

[dizzee_dee]

@slash2k

That fact, in and of itself, may have made the pharmacist suspicious: why does this person need to drive an hour instead of just obtaining/filling the prescription locally? You doubtless have perfectly good reasons, but instead of asking those reasons, the pharmacist may have just decided he was uncomfortable. (To my mind, the proper response would have been to call the doctor’s office while you waited, though, instead of brushing you off.)

Seriously? Pharmacies get scripts all the time from doctors that are not local. That’s what DEA and NPI numbers are for. :smack:

[MsRobyn]

@dizzee_dee

Seriously? Pharmacies get scripts all the time from doctors that are not local. That’s what DEA and NPI numbers are for. :smack:

Pharmacists get very, very good at reading prescriptions. Out-of-area doctors have DEA and NPI numbers, but depending on what they’ve prescribed, they may raise an eyebrow. Blood pressure meds? Not a problem. Pain meds? Not so fast.

[Ambivalid]

@MsRobyn

From what you’re saying, this is what I think happened. In this pharmacist’s judgment, something was off with your meds. Perhaps two or more interact badly, perhaps he had a question about the dose or the schedule, whatever. He may have your refill history in front of him, he may have you in front of him, and to him, none of those things matter. In this one pharmacist’s professional judgment, giving you this medication could cause you harm. Ethically, he’s bound to withhold the medication from you until he has talked to the prescriber and clarified to his satisfaction that the drug is prescribed as intended. If he has reason to believe that there is a problem with a prescription, and he doesn’t act on that belief, he’s guilty of professional malpractice. It’s that simple.

Most people think of pharmacists as technicians whose job is to count pills and hand them over to the customer. They’re not. They’re highly educated professionals who spend years in school and clinical training to learn specifically about drugs; how they affect the body’s systems and disease processes; how they affect specific populations; and how they must be adjusted in certain situations, and how to adjust those doses. Good doctors rely on pharmacists to answer questions about drugs and rely on them to make sure their patients don’t die because of a mistake. Patients rely on pharmacists to catch these mistakes and to counsel on how to take the drugs to make sure they work and don’t cause bigger problems.

Be grateful that there was a pharmacist who cared enough to inconvenience you, and be grateful that it was a simple thing that could be cleared up quickly.

As for the person who bitched about over-reliance on computers and how that replaces professional judgment, I had to laugh. Those computers are linked to the insurance companies for reimbursement and tracking purposes, and those store patient records and other information necessary for regulators and licensing. If you think the wait for a prescription is long now, think about how much longer it would be if the pharmacy staff had to spend time entering all that data after the fact.

Be grateful?! You must be kidding. As ive said multiple times, there was NO contraindicating meds, nothing “off” anout the scrip WHATSOEVER. It was the exact same scrip, filled at the exact same pharmacy for years. And g he only reason things got cleared up is because i took my scrip elsewhere. If that pharmacist was so concerned for my well being, why did he tell me exactly nothing as to what his problem was.

Id feel lucky if i never encounter such a “caring” pharmacist again.

[TBG]

@septimus

OK; I should have known whom to blame.

Oh, there’s plenty of other gov’t crap that’s caused other problems. Like thanks to HIPPA, the old folks home they’re at can no longer require residents to check out when they’re leaving the facility because it “violates their privacy”. Yeah, like a place chock full of old, senile, dementia suffering, etc residents might not have a good reason to be sure who is and isn’t in the building so that they can maybe know if old Agnes isn’t in her room because she’s out with her family for the day or instead wandered off due to her failing mental faculties.

[WhyNot]

@TBG

Like thanks to HIPPA, the old folks home they’re at can no longer require residents to check out when they’re leaving the facility because it “violates their privacy”.

That’s not true.

They may not be able to require them to sign in and out on an unsecured clipboard left out on the counter where everyone can read it, but they can still require them to sign in and out on a secured form that isn’t accessible to everyone else.

Whether the nursing home wants to pay someone to sit there and hand people a paper to sign and then lock it up is another matter.

[doreen]

@WhyNot

That’s not true.

They may not be able to require them to sign in and out on an unsecured clipboard left out on the counter where everyone can read it, but they can still require them to sign in and out on a secured form that isn’t accessible to everyone else.

This is a little off-topic, but what is the purpose of requiring the form to be secured? I’ve seen claims that doctor’s offices can’t have patients sign in on an unsecured form, and for the life of me , I can’t understand why , since I’ve never seen anyone say that the office staff must somehow find a way to call the next patient without everyone else in the waiting room hearing the name.

[WhyNot]

@doreen

This is a little off-topic, but what is the purpose of requiring the form to be secured? I’ve seen claims that doctor’s offices can’t have patients sign in on an unsecured form, and for the life of me , I can’t understand why , since I’ve never seen anyone say that the office staff must somehow find a way to call the next patient without everyone else in the waiting room hearing the name.

There is a great deal of argument as to whether calling out a full name in a waiting room is a HIPAA violation or not. Some argue it is, as it clearly reveals PHI to people not on the care team, others opine that it’s part of the “necessary” use of your PHI to provide treatment, which is allowed. Facilities are encouraged to, at least, investigate the issue, figure out if there’s some other way they can do it, and put it into writing why they cannot do it some other way if they can’t.

This is how lawyers make money.

Here’s one example of the debate: HIPAA and Calling Out Full Names In Waiting Rooms - Privacy and Security Brainiacs

[Senegoid]

Both at my doctor’s office (actually, a bunch of separate doctors’ offices in one big multi-suite clinic – Okay, we’re talking about Kaiser hospitals and clinics here), and at my dentist’s office, they call for patients in the waiting room by their first names only.

BUT they do something else too, that somewhat surprises me. The doctor’s assistant comes out of the back office, then walks right up to me and addresses me face-to-face asking me if I’m who she thinks I am, and invites me back into the office. They don’t just call out my name across the waiting room for all to hear, like they did 40 years ago.

This surprises me because, most of the time, I can’t see how the doctor’s assistant knows who I am. At my PCP’s office, it’s not always the same assistance, and I only go there once or twice a year anyway. At various specialists’ offices, like the gastroenterologist or the pulmonologist, they doctor’s assistant seems to know who I am even the very first time I’m there.

(Someone told me once that the receptionist, who prints out the appointment sheet that goes to the back office, write a note on it saying what color shirt I’m wearing or something like that.)

[Waltzes_with_Cacti]

In 2013 Walgreen’s was fined $80 million for improper dispensing of opioids. Even for a huge chain, $80 million is a helluva hit. I realize, Ambivalid, that you were dealing with RiteAid, not Walgreen’s. A fine of this magnitude reverberated throughout the drugstore chains, all of which, RiteAid included, have introduced strict dispensing rules lest they end up with a similar fine. So keep in mind that while the info below pertains specifically to Walgreen’s, you can bet RiteAid, CVS and all the rest have similar procedures in place.

Walgreen’s has instituted a one page checklist that has to be filled out every time a pharmacist receives a scrip for pain meds. Here’s the checklist:
http://ftpcontent.worldnow.com/wthr/PDF/WalgreensGFDdocuments.pdf

The following text is taken from:
http://www.wthr.com/story/23469086/2013/09/18/walgreens-secret-checklist-reveals-controversial-new-policy-on-pain-pills

…. 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)

[Ambivalid]

Interesting. Thank you.

[MrAvg]

I worked at a pharmacy many years ago and the pharmacist can hold on refilling if he or she has any concerns. They are concerned about many things, your health, timing, things new about the drug within the last 30 days. If it pain medication, all new rules are changing refilling.

[Ambivalid]

@MrAvg

I worked at a pharmacy many years ago and the pharmacist can hold on refilling if he or she has any concerns. They are concerned about many things, your health, timing, things new about the drug within the last 30 days. If it pain medication, all new rules are changing refilling.

After reading the info provided by the poster before you, the only possible explanation is that it was not refilled due to the fact that I’ve been prescribed this medicine for more than 6 months (its been two years). It seems like this is an internal policy pharmacies self-impose.

[chizzuk]

I’ve filled for 30 Percocet with no problem, then gotten the third degree over an Rx for azithromycin. You just never know. This is the antibiotic that comes in your standard Z-pack. The pre-packaged Z-pack contains 6 pills but my doctor wrote for 11, which required the techs to actually find the giant jar of pills and count them out in a bottle rather than slap labels on a blister pack. I was called up to the counter by the pharmacist and questioned on who gave me the prescription, what it was treating, why such a non-standard amount, what the doctor’s rationale was, and why I hadn’t been given amoxicillin instead (I’m allergic). Only then was the medication dispensed. And all this over pretty weak antibiotics.

On the one hand, it was sort of annoying and embarrassing, but on the other hand, I’m also glad the pharmacist was actually paying attention and inquisitive about something that stood out to her. I guess? You don’t exactly get hooked on azithromycin or go around selling it on the street for a profit, but errors (and bad physician handwriting) do happen.