This past November, the Washington Post published an article detailing how major pharmacy chains, including Walgreens, Rite-Aid, CVS, and others are facing a trial later this year over their ”role” in the opioid crisis. Now, the Post is reporting that those same pharmacies have turned around and sued physicians across northeast Ohio. The pharmacies are arguing that if they are found liable at the trial later this year, doctors and other prescribers should have to pay some of the penalty. The article explains how two Ohio counties, Cuyahoga and Summit, sued the major pharmacy chains, stating “a failure on their part to stop the diversion of prescription narcotics to the ”black market”. U.S. District Judge Dan Aaron Polster, who is overseeing the case, allowed the Counties to include “failures by pharmacists in dispensing the medications.”
Although only certain individuals are allowed to prescribe controlled medications, pharmacists bear an equal responsibility to ensure that each prescription is valid, and is not dispensed to an illicit user, or dealer. The argument by the pharmacy chains is that if their pharmacists are to be held liable for a failure in preventing the medications from reaching this population, the prescribing habits of the doctors that wrote these prescriptions must also be examined. All doctors who wrote the offending scripts should also be investigated. If those doctors were in the habit of writing prescriptions that were being diverted, then they should also hold some of the liability. A spokesman for Walgreen Company stated that,” …[W]e strongly believe that the overwhelming majority of prescriptions dispensed were properly prescribed by doctors to meet the legitimate needs of their patients.” Thus, one of the things that will be decided by this case is the nature of that ‘belief’, and to what degree should pharmacists rely on that belief when filling a script for a controlled medication.
The outcome of this case will be instrumental in shaping the professional relationship between providers, patients, and pharmacists. A pharmacist must know how to weigh several factors before making a professional judgement on whether to accept a prescription for a controlled medication. As a baseline, every pharmacist must always be aware of the federal and state laws that govern how and when a controlled medication may be dispensed to a patient. Additionally, every pharmacy chain has internal policies that are intended to help enforce compliance with those laws. There are, however, a number of other ”soft” factors that often play a role in the decision on accepting a controlled medication. Amongst those factors, this case directly impacts the trust that pharmacists build with the health-care providers that they work with.
During my time as a pharmacist, I was fortunate enough to work in a community where the healthcare providers largely understood that administering healthcare was a team effort. I have countless examples of providers who have gone above and beyond to make themselves and their offices available to me if I had any questions regarding the validity of a prescription presented to me. That availability built trust, and that trust in turn would lead to a better overall experience for our shared patients. It will be extremely interesting to see how this case develops, and what arguments are brought forward on either side of this issue.
If you’d like to read more on this subject I’d recommend this article by Joseph L. Fink III, BSPharm, JD, which discusses a suit wherein a provider sued several chain pharmacies alleging that, “first, that pharmacists at their pharmacies had refused to honor her prescriptions for controlled substances; and second, that when doing so, the pharmacists told patients that the basis for their refusal was that the prescriber was under investigation by the DEA.” Secondly, for a more in-depth view on some guidance provided to pharmacists on when and how to refuse filling a prescription, take a look at this slide-deck by the American Pharmacists Association.