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had trouble getting their medications. Walgreens recently came under fire


from U.S. Drug Enforcement Adminis- tration (DEA) and Department of Justice officials for alleged loose control of these drugs at a number of its stores in Florida, after which the company began rolling out new rules. Under a recent settle- ment, Walgreens agreed to pay an $80 million fine and institute stricter compli- ance measures to resolve allegations it violated federal laws on recordkeeping and dispensing of controlled substances and failed to report suspicious prescrip- tion drug orders. In response to the settlement, Wal-


greens said it is “fully committed to doing [its] part to prevent prescription drug abuse.”


Company officials told Texas Medicine


the recent policies are part of a number of steps Walgreens began taking back in 2011 to provide additional guidance and training to pharmacies on the proper handling of controlled substances; en- hance ordering processes and inventory systems; and place order quantity limits on all controlled substances. “We have also reminded physicians


and other prescribers of the legal re- quirements placed on pharmacists to verify that controlled substance prescrip- tions are issued for a legitimate medical purpose. To make that determination, pharmacists may need to gather addi- tional information, including patient di- agnosis and expected length of therapy. This diligence may take extra time,” the statement reads.


The company said it took similar action on a pilot basis in Florida, after which it significantly reduced the num- ber of tablets dispensed by pharmacies for the most commonly abused pain management medications. TMA recognizes the growing pressure


to control drug abuse. “But this should not be black and white. Pharmacists should be reaching out to doctors and having a conversation,” TMA Director of Payment Advocacy Genevieve Davis said. She added that TMA is working with


Walgreens officials to ensure the policy does not turn into administrative hassles for physicians or privacy issues for pa- tients, following reports that some phar-


54 TEXAS MEDICINE August 2013


macists are requesting faxed medical records before dispensing medications. The policy does not impact all medica- tions, only certain narcotics. Walgreens has not disclosed what medications its pharmacies are targeting, but so far, Ms. Davis said it appears to be pain medica- tions and some psychiatric medications. TMA and other state medical societ- ies also raised concerns that pharma- cists may be acting beyond their scope of practice in deciding the legitimacy of patients’ prescriptions. In light of federal pressures, other retail pharmacies such as CVS and Costco have begun adopt- ing policies similar to that of Walgreens in other states, Ms. Davis also cautioned. In an attempt to address the matter, the American Medical Association at its annual meeting in June adopted new policy responding to what delegates called “drug store chain intrusion into the practice of medicine.” The policy says pharmacies that make inappropri- ate inquiries to verify a physician’s ratio- nale behind a prescription, diagnosis, or treatment plan are interfering with the practice of medicine. It also directs AMA to work with the National Association of Chain Drug Stores, DEA, and other federal regulators to develop policies on reducing incidence of inappropriate dis- pensing and drug diversion. TMA is tracking the issue, and Texas physicians can report problems by email- ing paymentadvocacy@texmed.org.


The enrollment requirement for or-


dering and referring physicians was included in the Patient Protection and Affordable Care Act to address multiple issues, including combating fraud and abuse by making sure only those physi- cians who are appropriately enrolled in Medicare are providing services to Medi- care beneficiaries; ensuring that nonphy- sician providers are not ordering and re- ferring services they are not allowed to under the Medicare rules; and making sure that physicians maintain updated enrollment records with Medicare. Despite the delay, TMA Payment Ad- vocacy Director Genevieve Davis says physicians or other eligible professionals not currently enrolled in PECOS should take the initiative to enroll sooner rather than later. Eventually the edits will be turned


CMS delays PECOS enrollment deadline


Due to technical issues, the Centers for Medicare & Medicaid Services (CMS) says it has postponed automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional not en- rolled in the Medicare Provider Enroll- ment, Chain, and Ownership System (PECOS). So far, CMS has not indicated when it plans to turn on the edits, ac- cording to TMA Payment Advocacy staff.


on, and when they are, labs that fulfill orders for blood tests or specialists or fa- cilities that perform imaging procedures, for example, will not receive due Medi- care payments if those services were ordered or referred by a doctor not en- rolled in PECOS. The consequences also could harm physicians’ referral relation- ships, Ms. Davis warns. More information on enrollment guidelines and the delay is available on the CMS website at www.cms.gov/Medi care/Provider-Enrollment-and-Certifica tion/MedicareProviderSupEnroll/Medi careOrderingandReferring.html. TMA staff also recommends physi- cians monitor claims closely for any re- jections indicating the ordering/referring physician is not enrolled, and, if neces- sary, contact the physician and ask that he or she enroll in Medicare to prevent future denials.


TMA also has a free tool to help


screen physicians from whom you re- ceive orders or referrals to make sure they are enrolled in the Medicare pro- gram. That tool is available at www.tex med.org/pecos/. n


Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at amy.sorrel@texmed.org.


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