Pharmacist dismisses patients by order of DEA

The accident happened 10 years ago when Chris Young was 35. He owned a salvage yard in Maui, Hawaii, and his employee had hoisted a junker on a machine called an excavator when the hydraulics gave out. The car fell on him from above his head, smashing his spine…  To control the pain, Young, who has since moved to Florida, needs high doses of narcotic painkillers, but he can’t always fill his doctor’s prescription…

Young’s pharmacist is Bill Napier, who owns the small, independent Panama Pharmacy in Jacksonville. Napier says he can’t serve customers who legitimately need painkillers because the wholesalers who supply his store will no longer distribute the amount of medications he needs. “I turn away sometimes 20 people a day,” says Napier.

Last year Napier says federal Drug Enforcement Administration agents visited him to discuss the narcotics he dispensed. “They showed me a number, and they said that if I wasn’t closer to the state average, they would come back. So I got pretty close to the state average,” Napier says. He says he made the adjustment “based on no science, but knowing where the number needed to be. We had to dismiss some patients in order to get to that number.”

According to Napier, DEA agents took all of his opioid prescriptions and held on to them for seven months. Napier hired a lawyer and paid for criminal background checks on his patients taking narcotics to help him decide which ones to drop…

“What we’ve seen is dramatic reductions in our ability to provide appropriate care for our patients in pain,” says Dr. R. Sean Morrison, director of the palliative care program at Mount Sinai Hospital in New York. Morrison’s patient Ora Chaikin has been taking high levels of narcotics for years to control her pain. She has had multiple surgeries because her bones and ligaments disintegrate, a problem caused by rheumatoid arthritis and other autoimmune diseases. But Chaikin, who lives in Riverdale, N.Y., says her mail order pharmacy, CVS/caremark, has been denying her medications.

“Every month there’s a reason they won’t give me my medication,” says Chaikin. “Sometimes it’s ‘Well, why are you taking this dose?’ ‘My doctor prescribed it.’ ‘Well, why did your doctor prescribe so much?’ ‘Ask my doctor,’” she recounts. “That’s the dose that works for me and you’re made to feel like a drug addict.” …

In a statement, CVS/caremark said that the dosage of pain medication prescribed to Chaikin “exceeded the recommended manufacturer dosing.” It also said that she “continued to receive her controlled substance prescriptions from CVS/caremark without interruption.” …

Ora Chaikin’s wife, Roseanne Leipzig, who is a geriatrician and palliative care physician, says when it comes to narcotics, there is nothing in medical literature that says a dose is too high. “There is no maximum dose for narcotics,” she says. “It’s the dose you need to take care of the pain.”

The Florida Board of Pharmacy, which is responsible for licensing pharmacists and educating them on safe practice, has heard enough complaints from pain patients that it is addressing the issue in public meetings. In June, Lesley Young testified before the board on behalf of her husband. She said she has driven more than 100 miles trying to find a pharmacy that would fill her husband’s prescriptions for painkillers.

“I’ve had to do the pharmacy crawl like many of us here,” Lesley told the board. “I’ve been the one who had to go in and beg, crying, with stacks of his medical records, with stacks of imaging, only to get turned away, often rudely, saying ‘We don’t deal with those kinds of patients.’

The next Florida Board of Pharmacy hearing is set for Monday. A representative of the DEA has been invited to attend.

Because Florida is pretty much the only state where the media is reporting on the war against pain patients, you might think that it’s not happening in other states. Of course that’s not true. And the media is focusing on the pharmacy crawl, which is only one problem among many. I know that doctors are abandoning patients, or just refusing to treat pain patients, but the media isn’t looking at that problem.

Under comments:

lservies, on August 5, 2015 at 6:45 pm said:
In the State of Tennessee, the DEA has forced all state licensed pain clinics to reduce ALL patients meds to under 200 milliequivalents of morphine per day. For us long-time chronic pain patients who are opiod tolerant, that is next to nothing. The State law actually reads that all patients who require more than 200 milliequivalents of morphine doses per day are required to go to a state licensed pain clinic. And now, they won’t let the clinics dispense over that amount.

Picking Painkillers: Treating What Hurts Without Triggering an Addiction

It’s time to hear from Nora Volkow from the NIDA… because it’s Tuesday and Tuesday’s suck.

Though debate continues on Oxycontin’s ability to deter abuse, drugs designed to do so provide a potential safeguard in the swelling storm of opioid abuse. But these specially made formulations typically cost far more than their more simply designed generic counterparts. As a result, health insurance plans, including Medicare Part D plans, tend to favor generics, which don’t have abuse-deterrent formulations, as preferred medications in the lists of drugs they cover.

A study released in June by District of Columbia-based Avalere Health, a strategic advisory company that provides health care solutions, found Medicare Part D plan coverage for the now abuse-deterrent drug OxyContin decreased by 28 percentage points, from 61 percent to 33 percent, from 2012 to 2015.

By comparison, the generic Oxycodone Hydrochloride, which has no built-in mechanism to deter abuse, was covered by all Part D plans in 2015. Overall, the Part D coverage for all prescription opioids dropped 10 percentage points…

Pearson notes that the drugs are intended to stem intentional attempts at abuse, rather than keep patients from becoming addicted to painkillers in the first place…  But some patients who aren’t at high risk for abuse may still have cause to choose abuse-deterrent formulations, like concern that the drugs could fall into another person’s hands…

While a generic painkiller without safeguards against abuse can run less than $10 for a month’s supply, brand name OxyContin, with its abuse-deterrent formulation, can cost more than $150 per month, depending on factors such as dosing, pharmacy and available discounts.

And however awkward or embarrassing it may be, experts emphasize that patients should disclose to their providers any history of substance abuse, whether involving prescription drugs or substances.

Doctors are required to keep such matters confidential, and Volkow notes that a patient’s failure to disclose this information can undermine a physician’s ability to safely prescribe powerful pain medication.

There are these things called Electronic Health Records and PDMPs, which means that your medical record is no longer confidential.

She insists on the importance of full disclosure in addition to resisting the urge to take past opioid prescriptions to treat pain as it flares up, outside of recommended treatment protocols, since self-medication can increase the risk of becoming addicted to prescription drugs.

Really?  If it doesn’t sound reasonable, it’s probably not true.

Over time, patients develop a tolerance to opioids that requires taking more medication for the same level of relief. “The higher the dose, the greater the likelihood you can have adverse effects. And what are the adverse effects? One of them relates, of course, to addiction, and the other one relates to overdoses,” Volkow says…

You know, this “expert’s” opinion doesn’t take into account the millions of pain patients who remain on the same dosages for 5, 10 years, or more.

So what are some telltale signs a patient might be becoming addicted to a prescription opioid?

“If they start to feel that they are too preoccupied with the anticipation of getting this medication, they should actually discuss it with their physician,” Volkow says. She compares it to looking forward to a nice dinner. “You know that you’re going to have something that you like very much, and you start to think about it in an obsessive-compulsive way.”

Patients may not recognize this, thinking only that they’re looking forward to pain relief, so it’s important to be on guard to untangle the nuances, in discussing concerns with a physician, she explains. Conversely, putting off taking needed medication because of its powerful effect may, counterintuitively, also signify an issue.

“[Some patients] may have pain and they say, ‘I’m not going to take it, I’m going to last as long as I can to minimize the use.’ But what they are doing by allowing the pain to be very, very intense is that they increase the value of the medication because they are anticipating the relief from this very intense pain,” Volkow says. “So both of these behaviors can be early indications that the patient may be starting to be addicted to their medication.”

If you look forward to pain relief, you’re a drug addict.  And if you force yourself to suffer by delaying a dose of pain medication, you’re also a drug addict. Basically, if you take opioids, you’re a drug addict.

“People need to understand that these drugs are potentially addictive, even after short-term use in some people,” says Dr. Andrew Gurman,​ an orthopedic hand surgeon in Altoona, Pennsylvania, and president-elect of the American Medical Association. He prescribes opioids to help patients deal with pain when they recover from surgery.

“When you look at the number of people who are dying of drug overdoses, primarily opioids, the number of people who are impaired by addiction – these are the same kinds of numbers we were seeing at the height of the AIDS epidemic,” he says. “It’s frightening.” …

No, what’s frightening is the head of the AMA comparing drug addiction to the AIDS epidemic, even if it’s just the number of people affected.  And the number of people “impaired” by addiction? What does that mean? Who decides when a patient is impaired, the DEA?

The AMA announced last week the creation of a task force to reduce opioid abuse comprised of 27 physician organizations, including the AMA, American Dental Association, American Psychiatric Association and seven state medical societies, with an aim to identify best practices to address the epidemic…  Gurman does not serve on the AMA-led opioid abuse task force but is the AMA representative on the National Association of Boards of Pharmacy Stakeholders Group on Opioid Prescribing and Dispensing.

In addition to doctors looking at their prescribing habits and considering red flags, like patients seeking to obtain prescriptions for opioids from numerous doctors, health experts say it’s important to discuss all options to deal with pain. Heat, ice and even holding one’s hand above his or her heart, in the case of surgical patients at Gurman’s practice, as well as dealing with the mental components of pain, can all help relieve discomfort.

That can ultimately reduce the need for prescription opioids. “Both patients and physicians need to think about and perhaps talk about alternatives to manage the pain,” Gurman says.

Okay, I’m holding my right hand above my head, while my left hand is holding an ice pack to my face…  Oh no, I can’t reach the heating pad.  My hands are getting tired and my shoulders have started to throb.  If I had three hands, I could put an ice pack on my neck and shoulders…

Patients aren’t stupid.  They know about ice, heat, compression, and all the over-the-counter medications you can buy to treat and manage pain.  They also know you don’t have to see a doctor for these treatments. Usually, by the time someone spends money on a doctor for pain, they’ve already tried all these other methods and none of them helped.

So, how long can you hold your hand above your heart?  Maybe I should lie down to try this new pain treatment.

CVS Minute Clinic

Back in February, major pharmacy chains including Walgreen Co., CVS Caremark, Rite Aid, Kroger and Safeway all announced via the White House website — an official channel if there ever was one — that they were endorsing the Blue Button initiative. Blue Button, a protocol developed at the Department of Veterans Affairs and now open to the general public, is an easy, one-click way for people to download health records from provider portals for personal reference or sharing with other providers. The idea is to support consumer access to their own records and promote health information exchange…

Why We’re Picking Walmart And CVS Over Doctors’ Offices

CVS Health’s MinuteClinic, the market leader with close to 1,000 locations in 31 states and the District of Columbia, had more than 18 million patient visits in 2013, up from 5 million just two years prior, according to the company. It plans to have 1,500 clinics by 2017…

Locations like these offer basic check-ups plus vaccinations and treatment for minor ailments, and their medical professionals can write prescriptions. Unlike the pharmacy and grocery chains, Walmart is positioning itself as a true primary care provider, while both Walmart and Walgreens tout their services for patients with chronic diseases. Walmart sets a flat price of $40 per visit (or $4 for company employees), while CVS Health and Walgreens charge less than $100 for most treatments. Lab work, drugs, vaccines and other things carry additional fees…

Retail clinics also typically offer a less-comprehensive set of services than urgent-care centers, and don’t have as much high-tech equipment…

My guess is that they don’t prescribe opioids either.

Facebook posts CAN be used to prosecute benefit cheats in New York test case

Facebook has been told it must comply with almost 400 search warrants seeking users’ postings as part of a fraud investigation, a New York appeals court said on Tuesday. The 381 warrants helped build a massive disabilities benefits fraud case against police and fire department retirees. So far 108 people have pleaded guilty. Some defendants disclosed on Facebook that they flew helicopters, traveled overseas, did martial arts and led active, full lives…

‘Our holding today does not mean that we do not appreciate Facebook’s concerns about the scope of the bulk warrants issued here or about the district attorney’s alleged right to indefinitely retain the seized accounts of the uncharged Facebook users,’ the five-judge panel wrote…

A Manhattan judge sanctioned the warrants in July 2013, saying law enforcement has authority to search massive amounts of material to seek evidence…

The Minority Report for health care

Using Watson, IBM and CVS aim to predict when your health is about to decline

IBM’s Watson is used in healthcare, financial services, retail and education. Earlier this year, the company launched its Watson Health business unit offering cloud-based access to Watson for use on healthcare data.

1. Movie: Minority Report (2002)

It should be noted that Minority Report’s amazingly prescient predictions weren’t just random guesses about what the future may look like. Director Steven Spielberg told Roger Ebert that like Stanley Kubrick did for 2001: A Space Odyssey, he “consulted with industrial designers, futurists, advertising people, to try to visualize what the future world would look like.”

Prescription Drug Monitoring Programs – Much Promise But Limited Progress

Fundamentally, a PDMP is a central repository of prescribing and dispensing records pertaining to medications classified as scheduled, controlled substances by the U.S. Drug Enforcement Administration, but a PDMP may include any drug/substance of interest or determined to have abuse potential.

These days, the information is stored in online electronic databases allowing easy access to authorized individuals or agencies, such as law enforcement and drug control agencies, practitioner licensure boards, medical examiners, drug courts and criminal diversion programs, addiction treatment programs, public and private third-party payers, medication dispensers (e.g., pharmacies) and prescribers, and other healthcare providers. States vary widely in which categories of users are permitted to request and receive prescription history reports and under what conditions.

Individual state PDMPs also differ as to required prescribing information — such as, drugs of interest, dose/quantity, date dispensed, and dispenser, prescriber, and patient information, etc. — and time of entry into the database. Only one state, Oklahoma, collects data in real time — that is, at the same time that a prescription is filled — whereas, most states allow up to a week or longer for submission of data to the PDMP…

Beyond 1990, and with support from the U.S. Drug Enforcement Administration (DEA), PDMP administrators formed an alliance for mutual support and information exchange, and to help promote expansion of PDMPs to other states. At this time, PDMPs also started to extend data collection beyond Schedule II drugs; although, each state was free to select the drugs included. This also marked a new generation of PDMPs using electronic technology for prescription information collection, largely abandoning the need for serialized prescription forms…

Continued interest at the federal level, and focusing on reducing opioid-related problems, resulted in various economic support programs; e.g., Harold Rogers Prescription Drug Monitoring Program Grants and the National All Schedules Prescription Electronic Reporting (NASPER) Act. The U.S. Bureau of Justice Assistance helped to form PDMP assistance and training programs with a special emphasis on evidence-based practices. Through the years, other government agencies (e.g., ONDCP, CDC, etc.) and private industry (Purdue Pharma) provided additional assistance and support for program development.

According to the most current information, by the end of 2014 all 50 states and the District of Columbia (Washington DC) had or were nearing realization of a PDMP…

As a newly added concern, the recent hacking of online, electronic databases threatens the integrity of PDMP programs and the security of confidential patient information…

Ideally, PDMP reports would include data on all prescription medications, beyond just CII opioids, but most PDMPs are not designed to capture such extensive information…

Furthermore, while it is claimed that PDMPs do not infringe on the legitimate prescribing of controlled substances and simply make it possible to spot potential problems in patients deserving a closer look, an end result often has been a “chilling effect” on the prescribing of opioids overall…

Several dozen published and unpublished empirical studies on PDMP effectiveness have been summarized in the Pew report, which more than anything points to the difficulties of such investigations. At best, studies have been observational in nature, but most have been case reports of select aspects of PDMPs (e.g., increases in user satisfaction); the vast majority of studies reported favorable outcomes related to PDMP applications and practices. It is important to note, however, that none of the studies were of high quality and none examined improvements in patient care or health outcomes as a result of PDMP implementation and use.

The few broader-scope comparisons of all states with versus states without PDMP programs did not show outcomes favoring PDMPs. For example, an observational study by Paulozzi, Jones, et al. (2011) of early program effectiveness, spanning 1999 through 2005, found that states with PDMPs demonstrated unfavorably increased trends in drug overdoses and mortality, along with significantly greater consumption of hydrocodone. Interestingly, the only states showing improvements in overdose deaths and opioid consumption at the time included 3 states with PDMPs still using special prescription forms rather than newer electronic approaches. This suggested there were many challenges still to be overcome in developing electronic PDMPs and, while it cannot be stated that PDMPs themselves caused negative outcomes, the researchers concluded that, “…it can be said unequivocally that PDMP states did not do any better than the non-PDMP states in controlling the rise in drug overdose mortality.” …

Prescribers have not widely embraced the use of PDMPs, even though there could be some advantages of PDMPs for patient care. For example, a comprehensive and accurate history of pharmacotherapy-management is essential for clinical evaluation of a new patient with chronic pain. While reliance on the patient’s self-reported history is generally considered acceptable, it may lead to dangerous misprescribing. A PDMP might help to identify patients who are receiving multiple legitimate prescriptions for opioids or benzodiazepines, from different healthcare providers, and are at risk for complications from polypharmacy — but only if the PDMP tracks more than class CII opioids…

In states with PDMPs administered by law enforcement agencies, usage by healthcare providers was lower than in states with PDMPs managed by health or pharmacy boards.

In a recent survey of PDMP users in Oregon, almost all (95%) reported accessing the database when they suspected drug abuse or diversion in a patient, but fewer than half checked it routinely for every new patient or every time they prescribed a controlled drug. Clinicians also reported a variety of problems that arose when a PDMP report included “worrisome” information: patients often reacted with anger or denial (at least 88% reacted this way sometimes); nearly three-quarters of clinicians (73%) said that those patients sometimes did not return; less than a quarter (22%) reported that the confronted patients asked for help with drug addiction or dependence problems…

UCLA Health System reports data breach, millions affected

UCLA Health is the latest healthcare organization to be hit by a data breach. The Los Angeles hospital and healthcare network says it discovered on May 5 that hackers had penetrated the parts of the UCLA Health system that contain personal information, like name, address, date of birth, social security number, medical record number, Medicare or health plan ID number, and some medical information (e.g., medical condition, medications, procedures, and test results).

UCLA said it notified the FBI but didn’t say why it took it took more than two months to notify the 4.5 million patients whose records may have been accessed…

Steps for Responding to Social Security Number Breach…

4. BE WARY OF PHISHING ATTEMPTS. If you get an email or call from someone claiming to be from Anthem and asking for your personal information, do not provide it. Scammers often take advantage of breaches by offering to help and actually seeking to steal your information. Check with Anthem through the phone number you usually use or one from the phone book, if you want to confirm that such a contact is legitimate.

States Use Facial Recognition Technology to Address License Fraud

At least 39 states now use the software in some fashion, and many say they’ve gotten remarkable results…

But critics raise concerns about privacy invasion and potential abuse. While photo database access is limited to the department of motor vehicles (DMV) in some states, others allow sharing with law enforcement.

For a long time, it was hard for states to crack down on identity thieves and fraudsters, given their lack of manpower. But officials say that has no longer been the case since they started using facial recognition. Among the cases uncovered in the last two years:

_In New York, a sanitation worker was charged with impersonating his dead twin brother and collecting more than $500,000 in disability benefits over 20 years.

_In Iowa, a fugitive who escaped from a North Carolina prison while serving time for armed robbery in the 1970s was identified when he tried to apply for a driver’s license using another name.

_In New Jersey, a man was charged with using false identities to get two fraudulent commercial driver’s licenses to drive trucks. His licenses had been suspended 64 times, including six times for DUI convictions.

“A driver’s license is a strong, dependable form of ID,” Slagle said. “We want to make sure the people who are getting the licenses are who they claim to be.” …

One of the ways that people get prescription medications illegally is to use a false driver’s license.  Pharmacist Steve says it’s very important for pharmacists to know the difference between a real and fake driver’s license, and I assume this facial recognition software could also be used for these purposes.  Will pharmacies be the next place we see this technology in practice?

When I moved to New Mexico and had to get a new driver’s license, the DMV used this kind of software to identify me.  I noticed all the cameras when I walked in the door, but first thought they were just for security purposes.  However, they knew the reason I was there before I even walked up to the counter.  Yeah, it was a little freaky.

These facial recognition databases are being used like the PDMPs.  At some point, it’s likely that anyone who fills any type of prescription medication will be included in the PDMPs, especially as this information is shared in some states with pharmacy benefit managers and insurance corporations.  And like with PDMPs, this technology can obviously be abused:

You are walking down the street minding your own business when a police officer taps you on the shoulder from behind. “Excuse me, ma’am,” he says, “Could I see some identification?” You know your rights and you say no. “You don’t really have a choice, ma’am. We have a positive identification of you from a camera that says you are Jill Stokes. Are you Ms. Stokes?” You nod, confused. “You owe the city $500 in parking tickets, ma’am.”

That’s a benign but totally plausible example of how the eradication of anonymity in public via unchecked identification and surveillance technologies will fundamentally change our lives. For even more troubling examples, think about how easily a government agency (or corrupt cop) could identify and track a political activist, whistleblower, or domestic violence survivor in the once-anonymous, bustling streets of our (now surveillance camera laden) cities. The agent or cop doesn’t even need to be in the same city as his target…

Face recognition can only work like it does on CSI if every single one of our faces is in a database accessible to the FBI or to local police. After all, plenty of people are first time criminals. So to catch every criminal using these tools, you’d need to have a database ready with every face in it — whether or not someone has an arrest record, no matter what that arrest record looks like. For many of us, this kind of “guilty until proven innocent,” “everyone is a suspect” policing methodology seems Orwellian and distasteful…

Thanks to federal grant programs from the Department of Transportation, at least 35 states have active face recognition programs at their registries of motor vehicles. The states say they use the software to detect fraud and abuse, for example to catch someone applying for a drivers’ license under a false name when they already have an ID under their real name. But numerous states are increasingly using the face recognition programs for law enforcement purposes, too. And a new FBI program, disclosed to the public in documents submitted to the Senate Judiciary Committee during the July 2012 hearing on face recognition, makes good use of that federally-funded face recognition technology at motor vehicle registries nationwide for purposes quite apart from fraud detection…

The FBI is working with a number of states to bolster the locals’ face recognition capabilities, as well:

“In February 2012, the state of Michigan successfully completed an end-to-end Facial Recognition Pilot transaction and is currently submitting facial recognition searches to CJIS. MOUs have also been executed with Hawaii and Maryland, and South Carolina, Ohio, and New Mexico are engaged in the MOU review process for Facial Recognition Pilot participation. Kansas, Arizona, Tennessee, Nebraska, and Missouri are also interested in Facial Recognition Pilot participation.” …

To save money, insurance industry joins the war against pain patients

Click to access insurers_pire_4_web508.pdf

The Role of Insurers in Preventing Misuse and Abuse of Controlled Substances

Prescription opioid abuse cost the health care system $25.0 billion during 2009 (Birnbaum et al., 2011)…

As Dr. Len Paulozzi of the Centers for Disease Control and Prevention said, “There’s an awful lot of back injuries in the workers’ comp population and subsequent surgery related to back problems, and back pain is one of the most common indicators now of use of opioids in the
United States” (Johnson & Jergler, 2013). However, as a strategy to manage chronic pain related to tissue damage, controlled substances may not be particularly effective. Dr. Paulozzi continued: “Opioids might be good for use in the acute phase, say within six weeks after injury. But if it doesn’t improve the situation in the short term, continuation is not really indicated.” Worse, using opioids to control pain creates a condition called hyperalgesia, which makes patients more sensitive to pain from future injuries and less able to control that pain…

In 2011, the State estimated that giving permission to third-party payers to access the Prescription Monitoring Program database would yield reductions in total benefits paid for 3% of claims related to 2–3 opioid prescriptions, 5% on claims related to 4–7 prescriptions, and 7% on claims related to 8 or more…

States and insurers are implementing patient review and restriction programs. These programs, which a number of states have implemented, are sometimes known as Medicaid Lock-In Programs…

In Virginia, WellPoint Anthem Blue Cross and Blue Shield estimated that it saved more than $300,000 by restricting 100 patients to a single pharmacy…

MaineCare, which administers the State’s Medicaid program, has limited patients to 2 weeks of painkillers a year, although it does permit renewals in intervals of 2 weeks to patients who receive special permission. Patients with chronic pain that lasts more than 8 weeks are required to try such alternative treatments as cognitive behavioral therapy, pain acceptance therapy, and chiropractic treatment. Exempt from these rules are patients with AIDS or cancer or those in hospice settings…

PDMPs that include data pertaining to the patient’s means of payment can be used to determine if Medicaid patients are circumventing program restrictions by using cash to purchase controlled substances. Unfortunately, as of 2012, only slightly over half the states were sharing their PDMP databases with either their Medicaid or Medicare programs, and only Michigan allowed private insurers access to it (PDMP, 2014). Using its PDMP database, Washington State’s Medicaid program discovered that in the first 6 months of 2012, more than 200 patients had paid cash for dispensed controlled substances on the same day, and 500 patients had filled two or more opioid prescriptions for use during the same time period. The program also discovered that Medicaid patients were paying cash for prescriptions for controlled substances in 435 of its pharmacies, which indicated that they were out of compliance with their contracts (Best, 2012)…

Aetna’s Pharmacy Management Program is a four pronged effort to prevent the misuse and abuse of controlled substances. First, the program can limit coverage of any particular drug and can verify that the covered member needs the drug before approving it. The program also proactively notifies the pharmacist if the drug is prescribed at a level that may be inappropriate. Second, the program reviews each member’s prescription history before filling a new prescription. Third, members who are suspected of misusing controlled substances may be referred to a pain specialist or to Aetna’s Behaviorial Health or Case Management services, or they may be encouraged to enroll in a pain management program. Finally, the program may respond to members who decline offers of assistance by restricting them to a single provider or
by reducing coverage for refills. Following the inception of this program, opioid use among the carrier’s 4 million members declined 15% over the course of 2 years (Aetna, 2013).
Blue Cross Blue Shield of Massachusetts implemented a similar program…

Prime Therapeutics, a pharmacy consulting program, identified patients of concern based on a score developed from their use of controlled substances and doses of opioid analgesics in excess of 120 morphine milligram equivalents per day…

Found in the Search Terms for my blog:  “does workers comp ins. coordinate with my anthem for opiate scripts”

(5/21/2015) Opioid addiction suit puts workers comp payers on alert

Experts urge workers compensation payers to take steps to avoid overprescribing or doctor shopping following a state Supreme Court’s decision allowing patients to sue physicians and pharmacies for contributing to their addiction to opioids.

Nearly 30 people filed eight civil actions in Mingo County, West Virginia, Circuit Court between 2010 and 2012 that alleged a medical center, three physicians and four medical centers “negligently prescribed and dispensed” drugs that led them to abuse and become addicted to opioids, court records show.

Most were prescribed Lortab, Oxycontin and Xanax for injuries caused by automobile or workplace accidents. Most also admitted “their abuse of controlled substances predated their treatment,” and they engaged in “illegal activities associated with the prescription and dispensation of controlled substances,” according to the West Virginia high court’s May 13 split decision…

“It’s a slippery slope,” said Phil Walls, chief clinical and compliance officer at Tampa, Florida-based pharmacy benefit manager myMatrixx, the marketing name of Matrix Healthcare Services Inc. Pharmacies worried about the potential liability might refuse to fill — or even stock — some opioids, which could make it difficult for injured workers who really need the drugs to get them, he said…

What payers in most states can — and should — do to curb overprescribing is to ask workers comp physicians if they’re accessing prescription drug monitoring programs, experts said.

If not, “that obviously doesn’t mean they are prescribing inappropriately or egregiously, but it does mean they aren’t paying as close attention as they should,” Mr. Pew said. “It indicates a lack of due diligence on behalf of the physician and is an immediate red flag.”

Another way payers can prevent egregious prescribing is by requesting physician profiling reports and other data from their pharmacy benefit managers, experts said.

Only a small number of physicians and pharmacies actually engage in inappropriate or egregious prescribing and dispensing, Mr. Walls said.

An FBI raid eventually led some of the West Virginia physicians to lose their medical licenses and serve prison time, while one pharmacy and its pharmacist were “subject to disciplinary and/or criminal action,” according to records.

Drug stores refusing to fill pain medications

Pharmacist Steve said:  The above post appeared in a closed FB page for chronic pain… I’M SPEECHLESS !

The Walgreens that I have used for the last 27 years & is the closest to my house – just UNDER a mile away (.94 mile) has a new Pharmacy Manager who will not fill my class 2 prescriptions because I am in a different zip code!! Seriously how do I even reason with this type of insanity????

Under comments:

Barbara Fowler, on July 8, 2015 at 10:47 am said:
Reporting Walgreens won’t help. I’ve been fighting with Walgreens for 3 years over my pain meds and I’ve written letters of complaint to every entity you can imagine, including their own CEO, and nothing has changed. My best advice is to take your business elsewhere. The only thing they will ever understand is what impacts their pocket so I am encouraging everyone I know to go elsewhere. I know that is easier said than done these days, but the privately owned pharmacies are your best chance. Go in and explain your situation in person and talk to them. If you live in the Orlando area, I can recommend a great guy who is very supportive and wants to help. Good luck to you.

INDIANAPOLIS – Some Walgreens customers are sharing painful stories about their recent trip to the drug store. They say those routine visits to get pain medication were anything but routine, ending in humiliation, threats and accusations…

Robert had gotten his pain pills from the same Walgreens drug store for two years without incident. When he recently went to get a refill, that changed.

He was told the drug store now had to verify his prescriptions by talking with his doctor — and that could take up to five days. Since Robert had just one day of pain pills left (both his doctor and his insurance company prohibit him from getting his painkiller prescriptions filled early), the longtime Walgreens customer asked for his prescription back so he could take it to a different pharmacy.

The pharmacist refused.

“He said, ‘I’ve already started the process and now it’s out of my hands. I am not giving it back to you,'” Robert recalls. “I felt kind of panicked and I told him, ‘I don’t think you can do that.’ That’s when he told me to leave or he’d call the police… I had no choice but to leave them there until he was able to fill them.” …

The pharmacy will call and further investigate. They’ll say ‘Why is this patient getting this script? What’s wrong with them? What’s the diagnosis? How long are they going to be on it? How long have they been on it?'” explained Dr. Ed Kowlowitz, who runs the Center for Pain Management in Indianapolis. “They’re not just filling scripts anymore.”

Walgreens says its new policy is designed to curb prescription drug abuse, which is now a national epidemic.

But there’s another reason for the new rules: Walgreens has no choice.

They are part of a new settlement agreement the company reached with the U.S. Department of Justice and the U.S. Drug Enforcement Agency…

Just one day after Walgreens settled its $80 million federal complaint involving improper dispensing of pain medication, J.C. drove to her local Walgreens to get a monthly refill of her painkillers. That’s when she learned her Walgreens pharmacist no longer wanted her business.

“They refused [to fill] it. He said, ‘We suggest you take it to CVS. At this point we’re just feeding an addiction.’ He was very loud and it was right in the open when he basically called me an addict. At that point, I was just so upset I left,” J.C. said…

Under comments:

Donna Gargiulo Gonzalez Collins
Although my doctor wrote me a prescription for Tramadol for 6 pills a day (1 every 4 hours) Walgreens said they will only allow me to have 90 pills for 30 days. They say that is their policy! That is only 3 pills a day! How can Walgreens change my prescription going against my doctors orders? What can I do about this? By the way my insurance company also approved payment for my prescription as the doctor wrote it.

JW Smythe
Same here. Ongoing pain management prescription was refused because it’s “against policy” to fill it. They’ve been filling it. They flagged it in their system so I can’t fill it at *any* Walgreens. I went to a dozen other pharmacies today trying to find one that had it in stock. They’re all out of stock…

John Blaine · Bradenton, Florida
I have just got refused meds form Walgreens. Doesn’t calling the doctors for more information violate HIPPA laws? I believe they can only check if the meds have been perscribed. I just got refused service at walgreens for pain killers that I have been taking for 18 years. It took years for the doctors and I to come up with a combination of meds to ease the pain so I could have some kind of quality of life. My choices for my pains were, To keep taking these meds, Have a Morphine pack put in me or to have my leg cut off…

Marcy Elizabeth Pedersen · Cypress College
Walgreens treated me so badly, that i was having very depressing scary thoughts. I just had a pulmonary embolism, and needed my meds filled, but instead the pharmacist shredded the prescription and told me i didn’t need it and to go back to the emergency room!

Chronic whiner Says:
Fri, Jun 19 ’15, 7:13 PM

The exact same situation happened to me. I live in South Eastern Michigan. Same elevated lived enzymes, also chronic, debilitating illnesses that began with a shoddy gastric bypass in August of 2005, followed by 19 surgeries in an attempt to rectify the problems, and due to severe malnourishment, a feeding tube for 3 years, a severe blockage where my esophagus and pouch met, I now have degenerative disc disease in my neck, bulging and herniated discs all down my spine, scoliosis, arthritis, osteoporosis…. There’s more, I’m not even touching on the mental anguish, PTSD, etc etc… Pardon my tangent. My point is, my doc did the same. Put me on oxycodone to lesson the Tylenol I was taking, but I could not fill the script. 2 days of phone calls (that was a joke) and unbelievable mileage… And I STILL was unable to fill the script. My doc reluctantly had to prescribe the norco after all… No other option worked as well…

tanya Says:
Sat, May 23 ’15, 11:31 AM

Yeah walgreens told me the same thing the last time i tried to fill with them. They said they couldn’t fill pain meds with muscle relaxers or pain meds with anxiety meds. He called it a south florida drug cocktail and then he flagged my file so that any walgreens i went to would refuse me. I was with them for years n years…

legalpain Says:
Thu, Mar 12 ’15, 12:35 PM

I was a 8 year customer @ CVS I’ve been at the same pain doctor 10 yrs and then the pharmacy manager refused to fill my 6 scripts. Only 2 are narco! My wife and just spent 6 hours just trying to get them filled at another CVS. Yesterday between my pain appt and trying to find a pharmacy (again I’ve never filled early out of fear and same CVS 8 yrs) I spent 8 hours.
I’m on methadone and for some magical reason it can only be found at the place who refused me.  I even called corporate trying to find out what happened. And all I get is it’s all up to pharmacy manager and a big wig named Cathleen in corp.

Since when did pharmacist get to play GOD with my life? I never wanted any of this. I have a dying wife and son with multiple health problems. Money is tight and last month I had repeated seizurs from methadone while the CVS I always went to decided to fill one last time.
Now where do I go?

When the PDMP is down, pharmacist won’t fill prescriptions

It’s not enough for the pharmacist to talk directly to your doctor — they must also check the PDMP.  So when this database isn’t working for some reason, that’s just too bad.  How often do computer systems go down?

Frequently Asked Questions for PDMP (Alabama)

How do I report a patient that might be committing fraud?
If you suspect a patient is committing fraud, contact your local police department and file a report.

What does it mean when my patient(s) is not listed in the PDMP database? I contacted the pharmacy and was told the patient received their Rx.
There are several possible circumstances why a patient is not listed on a report:

The information in the PDMP database in not based on real time. There is a two week interval between the date of dispensing and your request. All searches should be a minimum of two weeks old…

Does the PDMP staff track consumer usage of controlled substances?
No. The PDMP database was established to assist state license regulators, practitioners, pharmacists and law enforcement to prevent diversion, abuse, and misuse of controlled substances. The goals of the PDMP are achievable through these professionals.

Is it “unauthorized disclosure” to place a PDMP Patient History Report into a current or prospective patient medical chart?
No. PDMP legislation does not have restrictions regarding the management of patient medical records…

Is it “unauthorized disclosure” if a patient request to review or receive the PDMP Patient History Report without signing a HIPPA release for his/her medical chart?
Yes. According to Title 20, Section 20-2-214 permitted users of the controlled substance database include: authorized representatives of the certifying boards, licensed practitioner (authorized to prescribe, dispense, or administer controlled substances), licensed pharmacist, and state and local law enforcement authorities.


The MPDR enforces very strict limitations, as defined by law, about who can access the information and what they can do with it (§37-7-1506 MCA). The following Montana-licensed health care providers can access the online MPDR service to view the prescription history of patients who are under their care or who have been referred to them for care: Physicians, Dentists, Naturopathic Physicians, Optometrists, Pharmacists, Physician Assistants, Podiatrists and APRNs with a Prescriptive Authority endorsement. Any individual can request a copy of their own prescription history from the MPDR. Authorized representatives of Medicare, Medicaid, Tribal Health, Indian Health Services and Veterans Affairs may also access the online MPDR service. In addition, law enforcement officers may subpoena information related to an active investigation, and Licensing Board investigators may request information related to an active investigation into alleged prescription abuse or diversion by a licensed health care provider.


Who May Request Patient Information?
Prescribers: yes
Pharmacists: yes
Pharmacies: no
Law Enforcement: yes
Licensing Boards: yes
Patients: yes
If other requester (specify): Physician Assistant, Nurse Practitioner, Prosecutor, Medicaid Fraud and Abuse, Medicaid Drug Utilization and Review, Workers Compensation State, Medical Examiner, Correctional Supervision, Drug Treatment Provider, Researcher, Prescriber Delegate, Dispenser Delegate, Mental Health Therapists.

How confidential can the information be if all these people have access to it?

A HIPAA violation, a $1.8 million verdict, and three takeaways

Second, a HIPAA violation may amount to malpractice. A violation can be as dangerous and as costly as a misfilled prescription. Under federal law, patients cannot directly sue under HIPAA. There is no “right of private action” by the law. HIPAA can, however, be evidence of the pharmacist’s standard of practice. A violation of HIPAA is negligence and may be used to establish duty. Violation of duty along, with an injury caused by that violation, may amount to malpractice…

Legally and ethically, a patient’s records may be used only for the benefit of the patient…

If this was really true, then the use of PDMP databases — freely accessed by law enforcement, other government agencies, and state medical boards — would be both illegal and unethical. Not that those two concerns make any difference to the DEA or state medical boards.

Insurance company tells hospitals: we shouldn’t pay if you’re careless with patient data

In February 2014, former patients filed a class-action lawsuit against Cottage Health and inSync (the company responsible for putting Cottage records in a secure online location), complaining that from Oct. 8 through Dec. 2 of the previous year, the records of people who attended any Cottage hospital from Sept. 29, 2009 through Dec. 2, 2013 were available online, and that inSync “failed to provide any encryption or other security to prevent anyone from reading the medical records.” …

This data included patients’ names, addresses and dates of birth, and sometimes their diagnoses, lab results and any procedures performed…

Letter from Unum dated April 10, 2015

Dear Ms. Stahl:

We received your request for an appeal review of your Long Term Disability claim on April 09, 2015.

We may need to request additional information on appeal. Please sign and date the enclosed Authorization to Collect and Disclose Information, so we may obtain information on your behalf. Some facilities require a special authorization. We may need to ask for another authorization in the future.

The enclosed Optional Authorization to Disclose Information to Third Parties allows us to discuss your claim with the individuals you list on the form.

During the course of your appeal, we may need to speak to you. If you want us to communicate or share information about your claim with a third party (such as your spouse, child or sibling), we need written authorization from you prior to speaking with the third party.

Since Unum refuses to use email, the only way it can speak to me is through regular mail. Makes the process rather slow, doesn’t it? And why would I want Unum to bother any of my family members, none of whom live with me? So Unum can look into my past and find additional reasons to deny my appeal?

This form also gives you an option allowing Unum to leave messages about your claim on your voicemail or answering machine.

I have no phone, which means I have no voicemail or answering machine.

If you do not want us to discuss your claim with a third party, or allow us to leave messages on your voicemail/answering machine, you do not need to complete this form, and may discard it.

Of course I don’t want you to discuss my claim with any “third party,” including my family members. But if I refuse, I’m sure Unum will use this as one of its excuses to deny my appeal. What to do?

Additionally, the form asks me to list the names of the third parties, including my spouse (I don’t have one) and there’s one line for “Other Family Member” and one for “Other person.” Now, I have a big family, but since I haven’t spoken to most of them for quite some time, I can’t think of anyone I could list on this form. So, I won’t be signing and sending this form back to Unum.

Please send the completed forms to the address noted above or fax them to 207-575-2354. You may use the enclosed self-addressed stamped envelope.

Faxing is expensive, so thanks for the return envelope. But as I said, it really slows this process down, doesn’t it?  If I thought this appeal process had any hope of reinstating my benefits, I would be both frustrated and angry at these kinds of delays.

We are committed to making an appeal decision within 45 days of receiving your written appeal. There may be special circumstances in which the review can take longer. We will notify you if more time is needed.

We both know that my appeal has already been denied, so please, Unum, feel free to take all the time you need before you make it official. In fact, I delayed opening this letter from Unum because I was sure it was the denial letter. And because anything to do with Unum just makes my pain worse, increasing my stress levels and making me angry, opening a letter from Unum is the very last thing I want to do.

Let’s see, should I take care of my own health or try to take care of this appeal? As if anything I say or do is going to make a difference.

Ms. Stahl, if you have questions about your claim or this process, please call our Contact Center at 1-800-858-6843, 8 a.m. to 8 p.m., Monday through Friday. Any of our experienced representatives have access to your claim documentation and will be able to assist you.

If you prefer to speak with me personally, I can be reached at the same toll-free number at extension, 59657. We will identify your claim by your Social Security number of claim number, so please have one of these numbers available when you call.

Katherine Durrell
Lead Appeals Specialist

cc: Beirne Maynard and Parsons/Jan Bright


When Unum’s field investigator interviewed me earlier this year, he requested that I sign another Authorization, even though the one on file was current. So, I refused. I have also requested that Unum provide an Authorization that doesn’t violate my HIPAA rights. And although this new Authorization to Collect and Disclose Information states, right at the top, that it is “designed to comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,” it really doesn’t:

“I understand that once My Information is disclosed to Unum, any privacy protections established by HIPAA may not apply to the information, but other privacy laws continue to apply.”

Other privacy laws don’t exist, especially for electronic health records, which is why Unum doesn’t list them. Additionally, the form authorizes not only health care and related facilities to release information to Unum, it also authorizes:

“…rehabilitation professionals, vocational evaluators, health plans, insurance companies, third party administrators, insurance producers, insurance service providers, consumer reporting agencies including credit bureaus, GENEX Services, Inc., The Advocator Group and other Social Security advocacy vendors, professional licensing bodies, employers, attorneys, financial institutions and/or banks, and governmental entities;”

That’s a long list of places where Unum will not find any of my medical information. Of course, Unum isn’t interested in using my medical information to deny my appeal — no, it needs access to all of this other information so it can find every other possible reason. You know, because my medical information, which includes a 25-year history of intractable pain, is just not enough to satisfy Unum.

What else do ya’ll want, my fingerprints and DNA? When will Unum tell me that I have to take a lie detector test?

“To disclose information, whether from before, during or after the date of this authorization, about my health, including HIV, AIDS or other disorders of the immune system, use of drugs or alcohol, mental or physical history, condition, advice or treatment (except this authorization does not authorize release of psychotherapy notes), prescription drug history, earnings, financial or credit history, professional licenses, employment history, insurance claims and benefits, and all other claims and benefits, including Social Security claims and benefits (“My Information);”

Unum collected all this information when it approved my claim 7 years ago. But in order to deny my appeal, it needs updated information because the information it already possesses in my file is insufficient. Well, actually, it’s plenty, since Unum doesn’t need valid reasons for terminating disability benefits. 

“For such evaluation and administration of claims, this authorization is valid for two years, or the duration of my claim for benefits, whichever is shorter.”

Authorizations shouldn’t be valid for such a long time. I will be changing this language on the form to indicate that the Authorization is only good for one year.  The other language I will include is:  “Unum should bear all costs incurred by any person or entity which supplies My Information to Unum.”

“If I do not sign this authorization or if I alter or revoke it, except as specified above, Unum may not be able to evaluate or administer my claim(s), which may lead to my claim(s) being denied.”

Well, my claim has already been denied when Unum terminated my benefits after 7 years of paying the claim. And now, because I can’t afford to pay for doctors to complete Unum’s forms (including a Functional Capacity Evaluation), and Unum refuses to pay for these services, my appeal will be denied.

It doesn’t matter how I feel about this Authorization, I have no choice but to sign it.  That pisses me off, and since anger makes my head throb even more, I just want to thank Unum for this exercise in increased pain and futility.

(Wish I had some bud or ranch dressing, but it looks like an ice pack will have to do.)