Secret at the Drugstore
Thousands of drug stores are quietly implementing new policies for dispensing pain medication. The changes affect millions of customers, but pharmacies don't want to talk about it. Some patients call the new policies invasive. Some doctors call them "horrific." It's the latest sign of a nationwide crisis and many pharmacy customers are finding themselves caught in the middle.
On a bad day, Vivian is in so much pain she won't leave her Muncie home.
On a good day, you might find her picking buckets full of strawberries at a local farm.
A chronic medical condition keeps Vivian on a constant roller coaster, and she relies on a powerful pain medication to balance out the good days and the bad.
"I have spondyloarthropothy. It's arthritis of the spine. Constant pain," she explains. "Some days, I count the minutes where it's time to take the pain medication again."
The mother and housewife does not want Eyewitness News to show her face. In fact, Vivian is not her real name.
She asked 13 Investigates to protect her identity because she does not want others to know she is taking the highly-addictive pain medication Hydrocodone, which has a high street value among prescription drug addicts.
"Someone who really wants it will break-in and steal that kind of drug so I worry about my safety," she said. "And in general, there is a stigma that comes along with it. Some people look at you like you're a drug dealer."
Among those people: her pharmacist.
"I couldn't believe it. I had called for my refills and went to pick them up and expected them to be there like they always had been for the past five years, but that didn't happen. They said no."
Vivian shakes her head in disgust as she recalls a Walgreens pharmacist in Muncie who would not refill her prescription for Hydrocodone -- unless her doctor was willing to tell the pharmacist more details about her medical condition.
"It made no sense. I had gone to that same pharmacy to get that same prescription filled for years, then they said ‘We can't fill this unless we talk to your doctor.' There were other people around listening and it was humiliating. I felt like they were accusing me of giving them a false prescription, so I said thank you and left and went to another pharmacy and my prescriptions were filled immediately."
She is not alone.
13 Investigates has heard the same thing happening to customers at Walgreens across Indiana and across the country: pharmacists refusing to fill prescriptions until they get more detailed medical information about you directly from your doctor.
"They're not just filling [prescriptions] anymore," said Edward Kowlowitz, a doctor at the Center for Pain Management in Indianapolis. "The pharmacy will call and further investigate. They'll say ‘Why is this patient getting this [prescription]? 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?' They are asking a lot more questions than they used to."
And Kowlowitz says it's now happening a lot.
"The large bulk is probably coming from Walgreens at this point, but we are seeing it across the board … All pharmacies are starting to do it more regularly now, and it seems they aren't really doing a good job of explaining why."
So why are some pharmacies not honoring prescriptions unless your doctor is willing to divulge your personal health information? And are they even allowed to do that?
The answer is yes; they are legally permitted to ask your doctor for more information. And they're doing it to stop a national epidemic involving the abuse of prescription pain medication.
Federal and state investigators have been cracking down on doctors and pharmacies that are allowing it to happen.
In recent years, several Indiana doctors have been charged and convicted of crimes involving the reckless dispensing of powerful narcotics and pain killers.
And just this month, Walgreens Corporation was fined $80 million dollars -- the largest fine in U.S. history for a violation of the Controlled Substances Act -- after federal investigators found massive problems at six Walgreens' drug stores and a Walgreens distribution center in Florida.
"These retail pharmacies filled the prescriptions for addictive prescription narcotics despite obvious red flags that clearly indicated the prescriptions were illegitimate and the drugs were likely to be diverted for street use," said U.S. Attorney Wilfredo Ferrer, culminating a year-long investigation by the US Drug Enforcement Agency.
As part of its $80 million dollar settlement with the US Department of Justice, Walgreens must improve what the company refers to as its "good faith dispensing policy."
13 Investigates asked Walgreens for a copy of that policy and for an on-camera interview to explain it. The nation's largest pharmacy chain declined both requests.
But a company spokesman did send WTHR a statement to help explain the intent of its policy.
"Pharmacists utilize our good faith dispensing policy as a key part of their effort to ensure that each prescription for a controlled substance is ‘issued for a legitimate medical purpose.' To make that determination, pharmacists may need to gather additional information, including patient diagnosis and expected length of therapy. This may be necessary on some, but not most, prescriptions. The policy helps them decide when steps are necessary and when they may not be. This diligence may take extra time, both for our patients, and for physicians. We do our best to minimize inconvenience," wrote Walgreens corporate spokesman James Graham.
No choice for pharmacists
It appears Walgreens pharmacists began implementing the policy in earnest early this year as USDOJ and USDEA reached the final stages of its settlement negotiations with the pharmacy chain. That is when WTHR began receiving e-mails and phone calls from viewers who said a vague new policy at Walgreens was impacting their ability to get refills of their pain medications.
At the same time, the Indiana State Medical Association published a report titled "Pharmacies creating barriers for patients filling controlled substance prescriptions." In the report, ISMA said it contacted Walgreens "to express concern about the drug store chain's lack of communication to the prescriber community in our state" and that other drug store chains – including CVS – may be taking similar action.
Industry experts say the federal government's crackdown sent a very clear message: pharmacists are now being held more accountable when it comes to pain pills.
"These medicines can be fatal and the government says they must be dispensed properly," said Bruce Clayton, associate dean at Butler University's College of Pharmacy. He says pharmacists must determine that each prescription is medically necessary and appropriate before it is dispensed. Those who fill questionable prescriptions for pain pills without asking questions can face severe consequences, according to Clayton.
"If you're doing that, you are not following federal law and state law regarding controlled substances and if prosecuted, one can lose one's license over it, so the pharmacist really has no choice but to collect that info when the prescription is filled," he said.
By asking more questions, pharmacists are now trying to catch customers who are abusing their medication and abusing the system.
13 Investigates found such a customer sitting outside Courtroom 5 at the Hamilton County Courthouse.
Busted by her drug store
Like Vivian, Lynn is a housewife and mother who asked WTHR to not show her identity. Eyewitness News agreed to her request to minimize potential harm to her family.
"I never dreamed in my wildest dreams that I'd be going to jail for anything," Lynn told WTHR. "I really don't want anyone to know about this. It's very embarrassing."
Lynn's prescription drug is Xanax. The Madison County mother started taking it for anxiety when her husband was deployed to Iraq. She got addicted to the pills and when she couldn't get enough, she got desperate.
"I just called the pharmacy and acted like I worked at the doctor's office and was calling a prescription in for myself," Lynn admitted. "It worked for a while, but then they eventually caught on and that's how I got in trouble."
A pharmacist at a Target in Fishers called Lynn's doctor to confirm a prescription for Alprazolam (a generic substitute for Xanax) and discovered the prescription refills weren't legitimate. The young mother was arrested and the pharmacist identified her in a police lineup. Lynen was booked into the Hamilton County jail, and two weeks ago she pled guilty to prescription fraud.
"It got out of control," she said. "I'm glad they caught me because I might still be addicted to Xanax right now."
Drug stores say that is why they are now being more careful and asking more questions. But doctors say it comes at a price -- for both doctors and for patients.
"Every day we have number of patients crying because their medications cannot be filled," said Dmitry Arbuck, a pain management specialist Indiana Polyclinic in Carmel. He says his office staff is now overwhelmed with phone calls from pharmacists who want more diagnosis and treatment information about his patients.
"It's horrific. We have two people full time doing nothing but trying for patients to get medications we prescribe. Nothing else. What a waste of time and money. We don't have enough time in a day to deal with all those really unnecessary obstacles," he said.
Local doctors tell WTHR it can take hours or sometimes even days for their offices to return all of the phone calls they're now getting from pharmacies. That means some patients are now forced to wait to get their medicine -- medicine they rely on to relieve severe, chronic pain.
"In my case, I needed the pain medication that day," said Vivian. "I was completely out and it had never been a problem to get a refill before."
Patients and doctors say some drug stores aren't taking into consideration the impact of their new dispensing policies.
"I think they're probably considering the impact on themselves and their ability to do business and their DEA license more, and not the patient," said Kowlowitz. "Absolutely, patients are getting caught in the middle."
In many ways, it's not just patients who are caught in the middle. Pharmacies are now in the middle, too.
On one side: state and federal regulators demanding a crackdown on fraud.
On the other side: doctors and patients trying to crack down on pain.
"Pharmacists and physicians, we're struggling to find the right balance," said Arbuck. "For us it's an inconvenience. For patients, it's suffering. Pure suffering."