State Change Could Help Patients Get Pain Medications

Oct 8, 2015

Reacting to pleas from desperate patients unable to get pain medications, the Florida Board of Pharmacy on Wednesday approved a rule change aimed at training pharmacists to change their mindset about prescriptions for controlled substances.

The change switches the rule from a focus on reasons to reject prescriptions for highly addictive narcotics to an emphasis on ensuring that legitimate patients get the medications doctors have ordered.

"Instead of starting out with trying to find a reason to doubt a prescription, you start off with an assumption that everything in the prescription is good, and you work towards achieving patient access," Florida Pharmacy Association Executive Vice President Michael Jackson said after the unanimous vote Wednesday morning.

The board's action came after a series of meetings on the issue earlier this year in which members of the Controlled Substance Standards Committee heard from patients, doctors and even pharmacists frustrated by the "pharmacy crawl," where patients have traveled to up to a dozen drug stores in search of their medications. The problem has escalated statewide in the aftermath of state and federal crackdowns on "pill mills" that earned Florida a reputation as the epicenter of a prescription drug-abuse epidemic.

At least one doctor told the committee about patients with chronic pain who had committed suicide after they were unable to get prescriptions filled. Other patients complained that pharmacists had refused to fill prescriptions because they could not prove that doctors' orders were "medically necessary." Some pharmacists complained that distributors had cut back on their supplies of narcotics out of fear of scrutiny from the U.S. Drug Enforcement Administration, which has imposed heavy fines on pharmacy chains and suppliers in Florida.

"I know this is emotional," Gavin Meshad, chairman of the committee and a member of the pharmacy board who represents consumers. "People are passionate about this. I think we're doing everything in our power to try to address the problem."

The rule begins with an affirmation that "it is important for the patients of the state of Florida to be able to fill valid prescriptions for controlled substances" and spells out for pharmacists the necessary steps to ensure that the prescriptions are legitimate and that patients should have them.

The rule also includes requiring pharmacists to take a two-hour, "Validation of Prescriptions for Controlled Substances" course to educate pharmacists about ensuring access to pain medications for "all patients with a valid prescription." Pharmacists would have until 2017 to take the course.

While the regulatory change won't have any impact on the amount of drugs pharmacies are able to order from suppliers, the education requirement should help alleviate the difficulty patients are now encountering, said Board of Pharmacy Chairwoman Michele Weizer.

"If (the prescription) is a legitimate purpose and we can get in touch with the prescriber if we need to, they should find it much easier than they have in the past," she said.

The change, which still needs to go through what can be a time-consuming regulatory approval process, also won't force chain pharmacies like Walgreens and CVS to revamp corporate policies that result in some patients being blacklisted or turned down even when prescriptions are valid.

But patients can take some steps to improve chances of getting their prescriptions filled, said Jackson, whose association represents independent pharmacies.

Jackson said patients should try to find pharmacies close to their residences or workplaces and establish relationships with pharmacists. Patients should also be "open about sharing their health information" with their pharmacists, Jackson said.

"If you establish a pharmacist-patient relationship, just like a physician-patient relationship, you'll have a health care provider who's more motivated to work to resolve your problems,'' he said. "But screaming and yelling at pharmacists will only create doubt in the pharmacists' mind that there's something going on here that they're not sure they understand."