At their 2013 annual meeting, the American Medical Association (AMA) adopted Resolution 218 regarding AMA’s belief that pharmacists are inappropriately contacting prescribers for prescription clarification. Resolution 218 which asks the “AMA to recognize inappropriate inquiries, work with other parties to achieve a prompt resolution, and failing a prompt resolution, pursue a legislative or regulatory solution.” What the AMA calls “inappropriate inquiries” are pharmacist calls to verify prescriptions, diagnosis and treatment plans for their patients. The Resolution seeks to discourage pharmacists, the last line of defense against drug diversion, from calling physicians with questions on suspicious prescriptions.
The Resolution caused immediate backlash from pharmacy organizations, with the National Community Pharmacy Association (NCPA) releasing a statement calling it “short-sighted” and stating that NCPA “supports a collective approach to controlling abuse and diversion.”
As pharmacists strive to be recognized as healthcare providers, the AMA Resolution attempts to leave pharmacists out of healthcare decisions and direct full discretion to the physician. Additionally, the Resolution goes against the DEA’s position that pharmacists are the “gatekeepers” when it comes to controlling prescription drug abuse. As long as the DEA continues to hold pharmacists to this responsibility, physicians should expect to receive calls verifying the legitimacy of controlled substance prescriptions.
Some major retail pharmacy chains have implemented their own methods to combat prescription drug abuse that do not involve the pharmacist contacting the prescriber. CVS attempted to contact 42 “outlying” physicians regarding their narcotic prescribing. CVS identified these outliers by comparing them to other prescribers based on various characteristics for prescriptions dispensed from March 2010 to January 2012. The parameters included prescriptions for hydrocodone, oxycodone, alprazolam, methadone, and carisoprodol. CVS compared physician trends in the same geographic locations, practice specialties, typical prescription volume and quantities, number of cash-paying patients, and number of patients between the ages of 18-35 who were receiving high-risk medications. CVS attempted to contact and interview the physicians in order to determine if their practices and tendencies were legitimate. The majority of the physicians failed to respond or to communicate effectively. Of the final 42 outliers, CVS stopped filling narcotic prescriptions written by 36 of the physicians and after nine months, only 3 physicians contacted CVS asking to be reinstated as a valid prescriber at CVS locations.
Walgreens targeted patients, now requiring the pharmacy to perform more stringent evaluations of patients with narcotics prescriptions. Walgreens implemented a new “Good Faith Dispensing” policy to ensure the safety of patients, to assist in complying with government regulations regarding controlled substance documentation, and to deter patients from abusing narcotic prescriptions. This policy requires Walgreens pharmacists to use their professional judgment and then contact the prescriber of each potentially problematic prescription, verifying the authenticity of the prescription, and ensuring that the diagnosis codes, billing codes, length of therapy, dosage, directions, and medication history (including previous medications that failed) are all correctly documented. According to the Walgreens’ website, in order to obtain a Schedule II Controlled Substance, a patient must supply proof that he/she has had a physical examination with the prescribing physician in the last 24 months, must pick up the prescription in-store, and must use health insurance to fill the prescription. According to the “Good Faith Dispensing” checklist, Walgreens pharmacists must thoroughly review patient profiles regarding their medication history and obtain photo identification from the individual dropping off and picking up each prescription.
PHSI anticipates that the need for pharmacies to call prescribers will only increase, especially as the Affordable Care Act is implemented and new healthcare models such as Accountable Care Organizations (ACOs) become more prevalent. The AMA’s resolution is a knee jerk response to a legitimate health care concern. After negative publicity, the AMA agreed to collaborate with pharmacy associations, federal agencies and other stakeholders. As originally stated in the Resolution, “the complexity of the relevant issues supports the need for our AMA to attempt to work with organizations such as the National Association of Chain Drug Stores to achieve an expedient resolution of the concerns raised in Resolution 218.”