The Texas Medical Association and
the Texas Pain Society (TPS) are moni- toring such pharmacy policies to make sure they don’t harm access to legitimate pain prescriptions. The organizations have not received any complaints about CVS, but last year heard from Texas phy- sicians that some patients had trouble getting legitimate pain medication pre- scriptions after Walgreens initiated its policy to limit or even refuse what they consider to be suspicious prescriptions for controlled substances. (See “New Walgreens Pain Medication Policy Could Harm Prescription Access,” August 2013 Texas Medicine, pages 53–54.) The policies stem from U.S. Drug En-
forcement Administration pressure — in- cluding serious fines — on pharmacies to put better controls on commonly di- verted drugs. TMA and TPS recognize the chains
are making a good faith effort to re- spond. But TPS Executive Director Krista Crockett says the policies are “an extreme reaction.” For patient safety rea- sons, “it’s always good for pharmacists and physicians to be in communication. And we would like for pharmacists to get more education about pain patients’ le- gitimate needs.” CVS says it used its national data-
base to identify “extreme patterns” of prescribing high-risk drugs, mostly pain medications. For physicians and provid- ers who cannot justify their prescribing habits, the pharmacy chain will suspend controlled substances dispensing. In its approach detailed in NEJM, the phar- macy chain studied the volume of high- risk drug prescriptions among providers in the same specialty and geographic region, as well as patients’ ages and pay- ment methods. Out of 1 million prescribers in the da-
tabase — including physicians, nurses, and physician assistants — the program found 42 so-called outliers. After con- ducting interviews, CVS said only six gave what it considered “legitimate rea- sons” for their prescribing habits, most of whom said they were the only practitio- ner in a given geographic area caring for patients with chronic pain. “Our program is certainly not a com- prehensive solution, but it provides some
sense of the kind of inappropriate pre- scribing that is going on in our health care system. We believe that some of these clinicians may be part of pill mills, doing cursory examinations in high vol- umes of patients, all of whom then re- ceive opioid analgesics,” wrote Troyen A. Brennan, MD, CVS executive vice president and chief medical officer and a coauthor of the article. “Pharmacists have an ethical duty, backed by both federal and state law, to ensure that a prescription for a controlled substance is appropriate.” Ms. Crockett says CVS’ data-mining
approach does raise questions about the methods the retail pharmacy chain is using to identify so-called problem prescribers. “There are dangerous drug cocktails we would agree would not be appropriate. And sometimes [prescrib- ing habits] could help flag pill mills. On the other hand, there are very legitimate
reasons why one prescriber has higher volumes than the guy next door” if, for example, a physician treats a large num- ber of cancer patients. She adds that such policies also raise
concerns about pharmacists practicing beyond their expertise. If after request- ing and receiving from physicians a pa- tient’s diagnosis, medical record, or oth- er documentation, pharmacists still are denying prescriptions, “that is a scope- of-practice issue.” TMA is tracking the issue. Texas phy-
sicians can report problems by emailing
paymentadvocacy@texmed.org. 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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January 2014 TEXAS MEDICINE 43
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