The giant pharmacy/PBM company has told some Florida physicians they will no longer fill their scripts.
The article by the St Pete Times’ Letitia Stein, reported “CVS pharmacies appear to be flagging prescriptions for a specific combination of medications with high potential for abuse — oxycodone, Xanax and Soma…”. CVS is focusing on a relatively small group of doctors; this isn’t a blanket policy. These docs received a notice from CVS stating:
“CVS Pharmacy Inc. has become increasingly concerned with escalating reports of prescription drug abuse in Florida, especially oxycodone abuse…We regret any inconvenience that this action may cause. However, we take our compliance obligations seriously and find it necessary to take this action at this time.”
Pharmacies are obligated to refuse to fill scripts they believe are questionable; some, including Titan Pharmacy in New York, believe strongly in this obligation. Unfortunately the vast majority don’t. If they did, the current disaster in opioid overdosing would be much less of a problem.
Which is a nice segue to our next news item – WorkCompCentral’s John Kamin reported [sub req] this morning that the widow of work comp claimant who reportedly died as a result of an oxycodone overdose can pursue death benefits.
That’s right – a comp claimant, who was receiving drugs as a result of a work comp injury, died and the carrier may be liable for death benefits.
In this case it appears that the prescribing physician was careful and judicious, as the patient was prescribed a total of 60 mg of oxycodone (equivalent to 120 MED, the generally accepted dosing limit)
. And, the patient’s toxicology report appeared to indicate much higher usage than expected.
With all that said, the warning here is clear.
Some number of work comp claimants die as a result of opioid usage, and the employers/insurers who own that claim may well face liability for a death claim.
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Perhaps if carriers are held liable for the deaths of workers who overuse, abuse or are otherwise being prescribed opiates for too long carriers will take more than a financial interest in getting those workers into treatment programs.
Back when I was a claim manager we had an injured worker with long term opiate use for a significant injury and when I attempted to direct that worker to a pain program that would wean him and therefore make him more eligible for work, his attorney complained to the DOL (it was an LHWCA claim) that such interference with his physicians was contrary to the law. If the courts find that intervention is in the worker’s best interest so death’s can be prevented I think carriers and employers will be in a much better position to provide care that will benefit the worker over turning them into addicts with no hope of full recovery.
It is no secret that the work comp house of insurance is often responsible for turning common workers into drug addicts. All of us in the insurance business are always looking to limit the liability exposure on a case in order to control the monetary cost ” for the client / employer of course”, which in other words would pump up the carrier profit margin on the case. Unfortunately we fail to be good stuards of the case from the start when we: (1) expect the adjuster who has 150 to 200 cases to be deeply involved in the medical aspects of a case, when that is only one component of one case and that adjuster has up to 200 cases. (2) Then we make that same adjuster responsible for authorizing the medical care on what can quickly become very complicated from a medical standpoint; when they have little to no complex understanding of the medications they are responsible for authorizing. My point is this if we understood that some times it cost a little more to save a lot and just do the right thing: for the injured worker, the employer and teveryone else involved in the process we wouldn’t be faced with the crisis we have today. We have created this monster with narcotics in this industry because on many levels we have failed to do our jobs. My hat is off to the CVS establishments of the world. Finally some one is acting responsibly.
The sad trending of narcotic use is ultimately a result of unethical doctors and some very smart business practices on the part of the purveyers of drugs such as Oxycontin.
Last night I took a young medical student to dinner from the University of Washington under a program that links practicing doctors with students to learn about specialties and life after med school.
Like others before her who I have met, this was a very smart person, committed to a life of service globally and locally. I wonder if those at my local medical school are a separate population, or if somehow good folks go south when they enter practice. Likely a bit of both as the UW captures students from about 5 states, has very high standards of admission, and Seattle has become the epicenter of global health.
There is a sad disconnect between those wonderful people in medicine representing truly the best and brightest, and those jokers on the margins that seem to populate certain regions, making money any way they can, regardless of the impact on patients and society. They and we know who they are. They are not only the drug over-subscribers but they are every physician who advocates for a test that is superfluous or a surgery that is not needed. It is the doctor who spends 10 minutes with a patient pretending to do an IME and those enablers who buy medical services by price rather than quality. It is the drug companies who create diagnoses like Fibromyalgia, and those doctors who blindly attend industry-sponsored seminars and drink the Kool-Aid rather than using their reportedly fine brains to analyze data and engage in best practices. Conrad Murray is in good company. It is only a matter of degree.
Let’s remember what a profession in general, and medicine in particular is supposed to be.
Excellent post. As you say, kudos to CVS. With the seemingly endless barrage of ads for various medications, it’s no wonder that abuse occurs.
I must admit that I’m a bit curious how the pharmacy deals with any potential discrimination policies.
My small pharmacy has been blacklisting certain doctors for three years now. One that we blacklisted was in the NY Times 2 weeks ago, in handcuffs. As for Workers comp patients and oxycodone, we have a large population of comp patients, and very, very few of them are on oxycodone. The real problem are doctor shoppers who usually pay cash. I think the comp poulation is getting a bad “rap” here.