By Peter Cohron
There is currently a furor and it is growing. It is a big social media issue and the numerous commentators are pretty much posting only words that are inflammatory. Two health care professions are taking opposing sides and the issue is threatening to divide healthcare when unity is needed. The war-in-making results from a proposed regulation for adoption by the AMA that states that pharmacists should determine the legitimacy of a physician (or other prescriber, I assume) and then fill it, without further questions.
The regulation arises out of a response by a Major Drugstore Chain to its punishment for having stores in Florida that filled massive amounts of controlled substances from pain pill mills. Also, the FDA and DEA have taken the position that pharmacists are now ‘gatekeepers’ in the effort to slow/stop the number of questionable controlled substance prescriptions currently being filled. In order to prevent any possibility of repetition elsewhere, MDC instituted a new policy of requiring the prescriber to answer certain questions before CS prescriptions could be filled. The policy required the pharmacist to speak with the practitioner about such information as the diagnosis, ICD-9 code, treatment plan, and past therapy that was tried and failed when the current prescription is for a controlled substance.
Physicians, in turn, took this questioning as being overly intrusive into the prescribing process as well as into patient privacy. One physician in Louisville, KY, sent all his patients a letter explaining the MDC policy and urged them to take their prescriptions elsewhere. Pharmacists, physicians claimed, were interjecting themselves into the diagnostic and decision-making process, a process that solely belongs to the phsician.
The AMA then sought to retaliate against MDC’s policy, the result being a resolution that tells pharmacists they are second (or third) class healthcare providers and to keep in their place. In short, “Be quiet and do as you are told.”
Pharmacists objected to this policy. These professionals have sufficient means to look into questionable prescriptions. Further, this policy is time-consuming to people who are facing cutbacks in help and demands for increased output.
First of all, MDC’s policy is going overboard. Once again, a few bad apples has a giant corporation fearful that all the fruit is going to spoil.In this respect, the need for preventive measures is justified. In a way, living in this litigious world, you cannot blame MDC.
Secondly, in also going way overboard , the AMA regulation matches MDC’s overreaction. Once again there is some justification. Doctors have seen their once great world eroded by prescribing rights to other entities, managed care, and government oversight.
Still, MDC’s policy and the AMA regulation are nothing more than knee-jerk reactions and they both need to be done away with. MDC is swatting a mosquito with a cannon. The bad apples could have been fired and reported to the Board. Rather than laugh and shake its head ruefully, AMA’s response was to buy its own cannon.
Pharmacists and physicians cannot take this kind of stance against each other. We need each other, we depend on each other, we rely on each other. From the pharmacist’s side, it is not merely a matter of soliciting business. Most of them also see themselves as providers, providers that patients talk to and confide in. The vast majority of pharmacists also know the degree of information they need to fill a prescription and they do not seek more than that when discussing the patient with the prescriber. And, yes, most physicians in practice today recognize pharmacists as a checks-and-balances insurance against a prescription that would harm the patient. Occasionally, physicians write something wrong on prescriptions; there are drug interactions, patients forget or omit to tell the prescriber an important piece of information that affects the prescription, etc. In short, most physicians welcome questions.
Major issues face healthcare today: managed care, reimbursement, staffing, overcrowding in some of the professions, government interference and oversight. An overarching concern in all the healthcare professions is the growing lack of autonomy to corporate policy and government rule; while this is the topic for another day, infighting between the professions is only going to speed up that erosion of autonomy.
Pharmacist and physicians need to stand together on issues of healthcare, not fight on different sides of dual over-reactions, if for no other reason than to stop these over-reactions. MDC and other companies like it need to recognize that there are bad apples and deal with them, not put out new restrictive or intrusive policies that affect thousands of people who do and did no wrong in their practice. When knee-jerk reactions do occur, organizations like the AMA (and APhA) need to be the calm source of common sense. Pharmacist and physicians with level heads need to act—and act together–to stop this corporate nonsense. The future of healthcare in this country is scary enough; if this fight continues to fester and grow, that picture will only worsen for all of us.
Houck, Larry K., FDA/Law Blog, ”AMA Tells Pharmacists:’Don’t Call us, We’ll Call you’” June 13, 2013, http://www.fdalawblog.net/fda_law_bl…call-you-.html
NABP Homepage, ”AMA Policy Deems ‘Inappropriate Queries’ From Pharmacies as Interference With Practice of Medicine” July 3, 2013, https://www.nabp.net/news/
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