Walgreens’ ‘Secret Checklist’ for Pain Meds

An investigation by an Indianapolis television station has uncovered new details about a “secret checklist” used by Walgreens’ pharmacists to screen prescriptions for opioid pain medicines. The mandatory checklist has been in place for several months and has led to many delays or outright denials in getting prescriptions for painkillers filled.

1024px-WalgreensonPalmThe “National Target Drug Good Faith Dispensing Checklist” requires Walgreens pharmacists to seek additional information from patients and in some cases their physicians if they have a prescription for any drug containing oxycodone, hydromorphone (Dilaudid), methadone, morphine, fentanyl or Opana.

The new policy was implemented after the nation’s largest drug store chain was fined $80 million by the Drug Enforcement Agency for violating its license and the rules for dispensing controlled substances.

The one-page checklist instructs Walgreens pharmacists and pharmacy technicians to copy a government photo ID for each patient and to run their names through a prescription drug monitoring data system.

“Inform the patient that it may take additional time to process the prescription,” the checklist states.

Possible “red flags” that could lead to the prescription being denied include:

  • A pain medication not previously filled at Walgreens
  • A new doctor writing a prescription for the same pain medication
  • A doctor writing a prescription who is not in a “reasonable geographic location” near the pharmacy.
  • A patient paying for a prescription in cash
  • A patient seeking an early refill of a prescription
  • A patient seeking an “excessive” number of pills
  • A patient taking the same pain medication for more than 6 months

Pharmacists are told to call the patient’s physician “if in your professional judgment a call to a prescriber is warranted.”

If such a call is made, pharmacists are instructed to ask the doctor to verify writing the prescription, what the patient’s diagnosis is, their expected length of treatment, and the date of their last office visit.

“Because of the legal requirements placed on pharmacists to verify that controlled substance prescriptions are issued for a legitimate medical purpose, pharmacists may need to gather additional patient information from their prescribing physician’s office.  This diligence may take extra time,” Walgreens said in a statement to National Pain Report.

“Our good faith dispensing policy is intended to be used consistently by our pharmacists for each individual prescription to determine whether the doctor’s office needs to be contacted. Our policy does not require prescriber contact for every prescription.”

Both the American Medical Association and the American Academy of Pain Management have been inundated with complaints from patients and doctors – not only about Walgreens – but about other pharmacies also making it harder for opioid prescriptions to be filled.

“Physicians in more than 20 states tell the AMA that several national pharmacy chains may be inappropriately restricting patients’ access to legitimate pain medication. Such roadblocks are creating serious barriers to patient access to needed medications – including those in hospice,” wrote Dr. Steven Stack, an AMA spokesman and former board chairman in a statement to WTHR-TV.

The American Academy of Pain Management has created an online complaint form for doctors and patients who are having trouble getting prescriptions filled at Walgreens.

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23 Responses

  1. ginbug says:

    Lauren, Please enlighten us on what you mean by a “huge problem”? Is it because you believe what the media shows and tells you about this “huge problem”? If so, then that explains a lot. Now ask yourself this, Why is it that this “huge problem” is the worst in the poorest parts of our country? Why was this allowed to go unchecked for so long? Why is the largest # of people that become drug abusers, are the poorest & least educated & have little to no access for help? Why is the dea given almost unlimited resources & power to fight an outdated, completely useless, & absolutely unwinnable war that does a thousand times more harm than good? Why was the war on drugs started around the sametime that prisons were allowed to become private for profit businesses that make at least twice as much money off of non violent drug offender inmates then violent crime inmates? We not only have more prisons and prisoners than every other country w/ 70%(& growing) now privatized & more than 60% of all inmates being non violent drug offenders! If the war on drugs is working so great at reducing drugs, then why is there not 1 single prison w/o major drug trafficking & abuse going on in greater numbers than ever before? If they cannot even keep drugs out of prisons, how can they control drugs on the outside?
    As for not knowing what the job of a pharmacist is, it is the pharmacist that needs to be reminded what the job is! The pharmacist, doc,& patient should be a cohesive TEAM that works together for the well being of the patient & not to judge, humiliate, torture, & put the patients very life in danger! While I have great empathy for the position that the dea has forced them into, I do not understand how they are allowed to turn away legitimate patients w/ legitimate rx w/o a very good reason as to why they knowingly put that patients life in danger! Maybe when enough people die & their families start suing these pharmacies & pharmacists, people will start to notice what is really going on! So do not lecture me or others like me, how we are ignorant about what jobs are or that our complaints are baseless & that we just expect to get our rx filled w/ no questions asked as that is NOT what at all what we expect! The only “huge problem” is how wrong we are treated & abused! The only way to control drugs & help people, is to LEGALIZE & DECRIMINALIZE ALL DRUGS!!

  2. Mary says:

    I am a retired/disabled RN. I have rheumatoid arthritis, severe joint disease, and a connective tissue disorder. I understand the need for narcotics to control pain. I also understand the need to closely monitor these medications. Doctors and pharmacists have a legal and ethical obligation to do so. Here in NY, before a doctor writes a script for a controlled substance, he or she must check a state registry to determine if and when the patient last received a controlled substance. The doctor then knows whether or not it is appropriate to write the script. When the pharmacy fills the script, the dispensing pharmacist must enter into the registry the medication, dose, prescribing information, and the date dispensed. This system is protects everyone: doctors, pharmacists, and patients.
    Most doctors I know also require pain management patients to sign a contract agreeing not to get pain medications from other doctors without notifying them, to use only one pharmacy to fill the narcotic scripts, to use the meds only as prescribed, to never transfer the medication to anyone else, and to submit to a urine test if asked to so. As an RN and a pain management patient, I have absolutely no problem with this. Anyone who needs pain management for chronic pain should understand why this is necessary. Furthermore, if you are taking your meds as prescribed, there should be no need to fill a new script early except in very rare circumstances.

  3. penny says:

    FOR THE ONE WHO THINKS SHE KNOWS EVERYTHING ABOUT THE TRUE HONEST PPL THAT CA. ITSNT CONTROL YOUR PAIN AND I WAS ALWAYS WITH 1PHARMACIST AND I CHANGED BECAUSE I DIDN’T HAVE PPL KEEP GOING AND GET THE MY MED UNTIL CVS THAT WAS MUCH EASIER FOR ME AN MY MOM WEN I CAN BARELY MOVE SO I DC WHO YOU ARE ITS NOT YOUR BUSINESS NOR ANYONE EXCEPT THE PATIENT AND DOCTOR. HAVE YOU HEARD OF TESTS THAT PRALOT. YOU ARE SO WRONG AND PPL LIKE YOU THATS WATS WRONG WITH YOU GUYS WANT TO CONTROL PEOPLE AND GET BIG HEADS. YOU HAVE NO IDEA WAT PPL GO THROUGH OR DO YOU WALK IN THERE SHOES. SORRY ABOUT YOUR LUCK BUT I DONT TAKE IT TO GET HIGH BECAUSE IM STILL LIVING IN PAIN EVERYDAY ASTRUGGLES AND I HAVE TOOK THE SAME MEDS FOR YEARS SO IT’S BEST YOU NOT PUT YOUR B’S ON HERE SAYING WE ARE TO MESSED UP TO KNOW WHATS GOING ON. YOU NEED HELP

  4. Lauren says:

    Pharmacists absolutely have the right to deny medications if they think the prescriptions are not legitimate. This is a huge problem in the US. People are dying everyday, everywhere because of addictions to prescription medications. Pharmacists and doctors are getting their licenses taken away because they don’t do this type of screening enough. For all of you who seem to have so much knowledge about the pharmacy profession maybe you should do some research and see what its actually all about. None of you complaining seem to even know what a pharmacist does, the education and training required, and what the job actually entails. But then again, you are all heavily medicated so that could explain a lot.

  5. penny says:

    Jackie yes I completely understand because my nephew is one of them but that doesn’t mean do this to the chronic pain people so yeah there are a lot who understand addicts but not everyone turns into them and i am one who suffers EVERY DAY IN PAIN THEY ARE TOTALLY WRONG FOR DOING THIS TO US THE INNOCENT PEOPLE WHO NEED IT

  6. penny says:

    I totally agree with a lot of you ginbug etc. I feel like they want us to suffer and maybe die us off because it will be less of us but I be damned if they have relatives that are chronic pain suffer they won’t let their own suffer that’s for sure

  7. Eric says:

    My wife has “been on the same opioid for more than 6 months”.
    she has had “different doctors fill the same medication.” (within the same office.. ex doctor, nurse, nurse prac.)
    she gets a “large number of pills”
    she uses “multiple pharmacies”
    she “pays cash at one”
    she MUST because her insurance does not cover
    her level of required treatment.
    she has to fill with her insurance one month
    and the next month “exactly 30 days” later she must
    fill at the 2nd pharmacy and pay cash to avoid an
    insurance denial even though the medication is in fact due.

    Looks like Walgreens and other pharmacies need a new checklist.
    Some individuals need these medications and are tired of the
    endless hoop jumping. Why don’t we screen the patients actual health records and treatment notes. Wouldn’t this be more responsible and effective?

  8. sharon says:

    I am a chronic pain patient. I was an LPN, doing alot of heavy lifting. Then a pick up truck rear ended me TWICE. From that day I have not had a day w/out pain, even w the meds. I hate the way they make me feel. I am on a constant search for a dr who can help w the pain w/out the opiates that make me feel just blah. My pharmacist when I complain to him about having to take the meds tells me “well some ppl have to take meds for the rest of their lives.” OMG, I do not want that. The only reason I take them is to relieve my pain. So many pharmacies, even one I used for 8 yrs, will ot fill my prescriptios for pain meds. (Walgreens) I finally found a phamacist who is empathetic. When I take my scripts in every month, he tells me well, alot of ppl have to take different meds for the rest of their lives. I’ve been to 2 neuro surgeons, chiropractor, physical therapy. And I just keep hurting. The thing is, no one can feel someone elses pain. So back when I was a floor nurse on a surgical unit, when a patient told me they hurt, I gave them their meds the dr ordered. Do not think for a second I get “high” or enjoy these opiates. Quite the contrary, I loathe them. But they do semi control the pain. What really bothers me is the ppl that r abusing them, and make it much much harder for an honest pain patient to get their needed meds. I did not ask the guy to hit me w his pick up.

  9. Francis says:

    Its not Walgreen’s fault, its the fault of every voter who checks the box for the “tough on drugs” candidate on election day. Sure, you think they are talking about heroin and crack users, but little did you know they are talking about getting tough on you. That’s right, a substantial bureaucracy has been created that views you as a potential criminal, and your simple attempt to fill a prescription your doctor gave you as potentially criminal behavior.

  10. Donna P says:

    I had a script written by my physician. For a controlled substance Temazepam; the WGreens pharmacist refused to fill the script because in his opinion the way my physician wrote it was to much medication. I had to go days without it so I could get in touch with the office let them know what the pharmacist said. Their office closes at noon on Friday. My appt was before they closed and my script wasn’t filled until the next week due to his opinion. What ever happened to “take 1 to 2 pills, capsules, etc unless otherwise prescribed by YOUR PHYSICIAN” NOT unless determined to be the correct diagnosis by the Walgreens pharmacist!

  11. ginbug says:

    Cheryl, I understand completely what you are saying and you should use the resources, like checking the tracking system and even calling the doc if you still feel uneasy. In this day and time, it is so much easier to “weed out” doc shoppers & drug seekers and if you find that the patient is doing this, then you have every right to deny them. However, this is not what many pharms are doing and are refusing to fill for no reason. Answer me this: If you have a pain patient that has been getting their meds filled at your store every month for years and have NEVER once gotten an early fill and has been with the same doc for over 5 yrs. would you then out of the blue with no warning, stop filling for this patient even though they have done nothing to be flagged for? this is EXACTLY what was done to me by cvs. If I am following all rules and laws, how could you possibley get in trouble for filling my rx? No you should not fill every rx with out question; but nor should you be able to refuse without good reason. You say it is the pharmacist that gets the blame if a patient od’s; but please tell me who gets the blame when something happens to me when i go into withdrawal because you turned me away for not reason? Every time you turn a legit, law abiding patient that has been on high dose, long term meds for absolutely no good reason, then you are putting that patients life in very real danger from withdrawal shock or even suicide if they cannot get their meds. When cvs did this to me, I had no idea what to do as they gave me no warning. even my doc called and tried to reason with them and even though it was not right, I even offered to let them see my medical records; but they would not do it and claimed that the dea would only allow them to fill for patients in a 5 mile radius, which was utter bullshit as that only included 3 docs! 2 days later i went to the er as I was afraid i was having a stroke due to going into withdrawal. the moment I told them why I was there and the meds I take they completely changed and treated me awful and sent me home even though my bp was 225/126! Then 3hours later I was rushed back because I I did end up having a stroke my heart stopped at least twice! I was in ICU for over a week, the stroke caused damage to my eyes and brain as now my short term memory is bad along w/ my concentration, and I get pains in my head that are unlike anything I have ever felt! and my heart was damaged also! My life will never again be the same and none of it had to happen and was all because a pharmacist wanted to play God! So you should really think about what could happen to patient who you refuse to fill for without a very good reason! If it were up to me, a pharmacist would have to show good reason for NOT filling their rx and if they cannot and that patient has done nothing wrong, then that is when you should loose your license

  12. Cheryl rph says:

    By the way grant that isn’t our job to just fill the prescription and the other person saying just check for interactions. No sir these drugs addicts go to. Multiple doctors and multiple pharmacies to fill these rxs and whose liable??? The rph that filled one of those rxs when the patient overdosed.

  13. Cheryl rph says:

    First of all I want to say that as a pharmacist I have the right to decline a prescription if I chose. This is my license and my livelihood and those that say you should not question it just fill it are obviously drug seekers. I see these people on a regular basis. I have been in this practice long enough to realize who the legit people are. I do not doubt nor deny rxs from oncologists or hospice because no doubtedly they are for a legit purpose. But this is our license and there are legal ramifications for filling rxs for pts that overdose or are caught selling them. Our license is on the line as much as the dr that wrote it. So therefore it is our right as pharmacists.

  14. Lucy says:

    If you go and read your individual state and dea laws you will find that this is law and has been for atleast 30 years. If not followed there would be no doctors or pharmacist to dispense any pain pills. You guys fuss because youre inconvenienced but what about the innocent practitioners and pharmacist that have been incarcerated or lost their lives trying to fill a supposedly good prescription. Addiction is a problem that needs to be fixed and atleast they are trying. Yes its not perfect but with time it will be better.

  15. Jude says:

    I am a chronic pain patient and a retired EMT/EMT-Instructor due to my pain, and what I find irritating is that the American Medical Association (AMA) are working to finally treat chronic pain patients in a proper way, and not as drug seekers/addicts, after so many years of treating people as rubbish and/or by send them to see a psychiatrist when they complain of unrelenting pain. I know a lot of doctors still do that however the AMA does not currently take that view.

    The Pharmacists are not only taking up where the AMA left off, but added on their own hot pile of crap. Plus in Walgreen’s attempt to cover their asses so what happened, in the case they were fined $80 million, will not happen again they went from being lax in some cases to being controlling beyond their lawful grasp without even looking at the middle ground. They (and others) now act as if they are prison wardens.

    I’ve actually gotten to the point where I keep a few copies of a medical paper (from a physician not something I created) explaining the difference of those addicted to pain killers and those who are medically dependent on the medications. I give the paper to any new hires at the pharmacy I’ve used for the last 10 years, and others who wish to debate the topic. The worst for the pharmacies is they will end up in yet another class action law suit that we constantly hear about, where the only true winners are the lawyers.

    As for the AMA I just read an article in “MedScape” titled “A Narrative Review of the Impact of Disbelief in Chronic Pain” and how the doctors can approach it without delegitimizing a patients claim of pain.The piece can be read here:
    http://www.medscape.com/viewarticle/810602_1

  16. ginbug says:

    While I understand the need to be careful; but the way all of this is being handled, is just plain WRONG!! It is not just walgreens that is doing this, many other pharms. are doing it too. No matter what a patient does, or how legit they are, they are all being lumped together and judged as a group.
    The other HUGE problem is the fact that many small, “mom & pop” pharms. are taking advantage of desperate patients trying to find someone to fill their rx by price gouging them! Any other business that price gouge customers, especiall during a crisis, would get in alot of trouble as it is illegal! So why are they allowed to continue and become EXACTLY the same as a drug dealer selling on a street corner? According to walgreens, the reasons they list for flagging a person and denying to fill are impossible for chronic pain patients to NOT be flagged!
    There are many legit reasons & honest answers for there flag questions. Here they are:
    1. 1st time filling at walgreens-could be new patient or reg. pharm is out. easy to call doc and/or reg pharm to validate
    2. new doc-maybe they moved or transferred to new doc, or like in my case, my doc got cancer & retired. easy to call new doc to validate.
    3. paying w/ cash-if the patient doesn’t have ins. how else are they able to get their rx filled? easy to validate.
    4. As for the early fills, it would depend on how early and why and customer history. Again, easy to validate w/ doc.
    5. Exactly what amount would be considered excessive?
    6. Why is being on the same meds. for more than 6mo. a flag? If the meds are needed and working good for the patient, why change it?
    I live in a 24/7 nightmare of pain that I did NOT choose to have; but I am judged and punished for it as if I had control over it. Why am I treated any different than any other patient that has to be on matinance meds. to control their illness/condition, in otder to have some quality of life? Bp meds. do not cure high blood pressure, insulin does not cure diabetics, zoloft does not cure mental illness. Yet all those patients get their meds without having to jump through hoop after hoop and without any judgement! If they got cut off cold turkey because they could not find anyone to fill their rx, there would be a HUGE outcry from everyone, especially if they started dying because of not being able to get their meds. I need my meds just as much as they do; but because the meds I desperately need can be abused & addictive, I just don’t matter! The message that is being put out there so heavy, is that we as chronic pain patients, are nothing more than a bunch of junkies that deserve to suffer!!!

  17. Diane says:

    My daughter has a lot of health problems which require pain meds. One night I had to take her to the ER for a possible broken bone. The ER doctor wrote her a script for some pain meds as well as prescription strength ibuprofen. I dropped her scripts off at the pharmacy (not Walgreens) and later I went back to get them and I got told because she was on one pain medication for an ongoing condition that they were not filling the pain medication, even when I told them she gets the first on for one condition and is not supposed to use it for other problems. I went to the NP that has her on the one medication for the ongoing condition and she could not believe it, then I notified the district pharmacy manger and complained. Their job is just to fill the meds and watch for allergic issues ect but not to make a call because someone has one medication they will not fill any others. Craziness!

  18. cathy says:

    unfortunately, as a retail pharmacy manager (for a different company) I can say this happens all of the time. Walgreens was just dumb enough to make it a written policy. Pharmacists are given too much power and develop god complexes, thinking they have the right to determine your treatment. they don’t. their job is to fill the prescription, and if they doubt it’s validity they do have the right to verify it with the prescribing doctor, but THATS IT. They have no right to your other personal info, (HIPAA!) so do NOT give it to them. take your business someplace who will appreciate your business and respect your personal rights.But don’t just walk, complain to the company loudly until they listen. Also, there is a number for HIPAA complaints and violations which can easily be googled. this type of treatment is grossly unfair to chronic pain sufferers and lets face it, its a very dumb business practice.vote with your feet!

  19. Colleen says:

    @jackie

    Your comment obviously shows that an addict has affected your life; however, if you have ever been in chronic, debilitating, and constant daily pain maybe you would understand and not be so judgmental. Not every single person who takes pain killers are addicts. There is a major difference between being an addict and legitimately being prescribed a script for a diagnosed permanent injury and/or injuries. Not every person who takes painkillers are looking to get high; almost all people are looking to reduce their pain to manageable levels to lead a somewhat decent life. It is not the fault of a responsible adult that has a condition(s) that requires the use of painkillers. It is also not their fault that science has yet to find a way to alleviate pain besides useless (most times) surgeries, various injections, and painkillers. Furthermore, it is not their fault that some scumbag junkie decided to get high off pills, usually bought off the street, and became an addict.

    This problem with Walgreens is actually their own fault:

    http://www.fierceretail.com/story/walgreens-fined-80-million-largest-dea-history-unprecedented-number-record/2013-06-11

    This is just one of the many articles about this.

  20. Jackie says:

    If you have ever had someone addicted to prescription drugs, you would understand.

  21. Donna Lack says:

    I will never go to Walgreen’s again. I went to fill a narcotic prescription and they asked me to sign a photocopied medical release that looked like a fourth-grader composed it. It had no expiration date, did not specify what information they could have, how it would be kept private, etc. When I said the release was very unprofessional and I would not sign it without at least an expiration date, they wouldn’t fill my prescription. The pharmacist said he decides whether I get my medication, not my primary doctor. Very rude and unprofessional!

  22. Grant says:

    Do you know what a pharmacist’s job is? It is to read and fill the goddamned prescription that is prescribed by a physician. Not to question, interrogate, or even require a diagnosis. It is to read and fill the damn prescription. That is all. The pharmacists at the VA have started this shit too. Denying prescriptions that my doctor has submitted because they don’t think that I should have it. And people wonder why people snap and start killing people. In my opinion, they just cant stand the stupidity any longer.

  23. MELISSA HOWE says:

    My husband and I are both on pain meds. last month my husband had to go ta a walgreens on the west end of town. we have had many drugs filled there including the pain meds. we decided to go to one closer home. Any way the pharmacists would not fill he order because he wanted all my husbands medical records. there is no reason for all medical records. so my husband left and went to the one closer to home and asked the pharmacists what is required to have a pain meds prescriptions filled and the pharmacists said that only a drivers license or photo id and the prescription has an id number on it for controlled substance. all this information goes into a system and the government can see it and you pain management doctors can see when you have the prescription filled by date and time. I know that a person had to have an procedure done and needed meds for that to be done. Walgreens wanted to know why they had to have it done. what have happened with the hipa act. these people are not medical doctors. we are changing from walgreens when our insurance is up for renewal. I have no insurance until Nov. because that is when my medicare kicks in. I pay cash for my meds and I do not go to different places to fill my meds. we do our best to stay at the same place unless they dont have the meds to fill the order and we go to another walgreens. that does not happen very often. this company is going to lose a lot of people and we are 2 of them.

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