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Thread: Question for Phamacist Steve---DEA 'Limits'

  1. #1
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    Default Question for Phamacist Steve---DEA 'Limits'

    Steve, hopefully you can answer this question, thanks. I can never get a straight answer from the pharmacists who work at "W" chain store about this policy. When I tell them that I don't understand the policy, the pharms just tell me that it's because of 'abuse' or 'diversion', etc. They don't seem to understand my question. I'm not asking WHY they have this policy, I'm asking for the details of the policy.

    I understand that about 2 years ago (or so) the DEA instituted this policy of 'limiting' the quantity of each pain medication that an individual pharmacy can order per month. I have no idea why "W" chain store could no longer get my full quantity of dilaudid suppositories, while the indy pharmacy down the street could get the FULL quantity in only one day! (It takes other stores almost 2 weeks to get the order for this med, if they get it at all).

    Now, the ONLY indy pharmacy in my area has finally closed down, so I'm no longer able to get my meds from them. I feared that this day may occur, since indy pharmacies are closing every day. They had been in business since 1935.

    When I filled my regular meds at "W" chain store, I told the pharmacist that the indy store where I'd been getting my dilaudid supps had closed down. I told her I have no idea what I'm supposed to do now. She told me that they have one other patient who gets a certain quantity of dilaudid suppositories per month, and that's the reason why they are no longer able to fill my script for dilaudid supps.

    The pharmacist told me that she would send an email to their distributor, asking for an exception to this stupid rule. IF they make the exception, it will make my life SO much easier! If they deny it, I'll be in a world of pain. I'd have to drive 60 miles round-trip every single month, because that's the location of the ONLY indy pharmacy left in my area. I'm in too much pain to handle the drive, plus gas is crazy expensive and my car is old.

    My question: Is it each individual "W" store that is limited to receiving a certain quantity of dilaudid supps per month? If I took my script to a different branch of "W" pharmacy, might they be able to obtain it? When I asked my pharmacist this question, she just said they'd have to order it, which I understand, because almost no pharmacies keep dilaudid suppositories in stock. But she made it sound like another branch of "W" would NOT be able to fill the full quantity, either. I'm very unclear about this policy.

    The DEA 'limits' must be per each store? They couldn't be for each city or town, because population varies from town to town. I'm just wondering if another branch of "W" pharmacy might be able to get my dilaudid supps? We have several branches of "W" chain store around here. What we lack is an indy pharmacy.

    I currently left my script for dilaudid supps at a grocery store pharmacy. Not surprisingly, they were only able to get a partial quantity, and it will probably take them 2 weeks to get the full quantity, if at all.

    Steve, thanks so much if you can explain these 'limits' to me! I'm in chronic pain and just need my meds. This is all very frustrating. Maybe if I understand the details of the policy, I'll be able to figure out where to take my script to get it filled.

    Thanks,
    Eva

  2. #2
    Distinguished Community Member Pharmacist.steve's Avatar
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    Eva...

    This is a very complex issue.. the DEA states that they are not telling the wholesalers to ration controls... but.. while the wholesalers won't say.. they are doing it.. to everyone.. What is known that the wholesalers have developed this system that a pharmacy is only allowed to purchase a certain per-cent of controls to their total purchases.. To the best of my knowledge, the wholesalers will not tell a pharmacy what their limits are or how they are calculated.. just at some point in the month.. controls ordered from the wholesaler is no longer being sent. The genesis seems to be from a issue in Sanford FL about 3 yrs ago and two CVS stores that were filling any control Rxs presented to them.. from "pill mills".. the DEA determine that their wholesaler ( Cardinal ) knew or should have known that these two pharmacies were filling prescriptions for people that did not have a real medical need.. Keep in mind that Cardinal never saw a prescription nor a patient. In the end, it cost Cardinal a reported 34 million dollars in fines and legal fees and the DEA yanked the DEA license for their distribution center in central FL for two years.. And of course all the wholesalers over reacted -- there are three wholesalers that control about 80%-90% of the market. Also in 2011 or 2012 Walgreens was fined 80 million dollars by the DEA. CVS in OK was fined 11 million.. CVS was just fined 29 million in CA.. and the DEA is not auditing 4 COSTCO stores in N CA. The wholesalers are even completely cutting off pharmacy from buying controls.. I know of three .. two in CA and one in AZ.. I got a call last week from an attorney in CA that is representing some independents over this issue..
    You need to read this post on my blog and the links in the post.. This may present a avenue for those in the chronic pain community to get the attention of the wholesalers and the pharmacies and help them to get their medications. http://www.pharmaciststeve.com/?p=5246
    Unfortunately .. there is no real easy answer..
    The fear in the pharmacy community is real... they have seem to have taken the position that they would rather deny a legit pt their needed medication rather than take the risk of a single dose getting into the wrong hand. Given that there are a estimated 6 million people abuse drugs and a estimated 100 million chronic pain pts.. the odds are that they are causing more harm/suffering in the chronic pain community.. than stopping drug abuse... the current stats out there indicated that Heroin use/abuse/deaths are increasing dramatically.. those that want to abuse some substance. will find some substance to abuse.. I have heard stories of some chronic pain pts.. have gotten so desperate that they have had to turn to "the street" to get some of their needed medications.. which is very dangerous.. there is no quality control on street drugs..
    Pharmacist Steve
    www.pharmaciststeve.com

  3. #3
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    Cool Thanks

    Steve, thanks for explaining the policy to me. No wonder I can't get a straight answer from the pharmacists---I guess they're as confused about the policy as I am. I had thought that maybe the pharms knew the details but just didn't want to take the time to explain it to me. But now I understand that the pharms really don't know the exact numbers on the DEA-imposed 'limits'.

    This month, I took my script to a grocery store pharmacy. At least the grocery store is fairly close to my house. It took two orders and 11 days, but they finally got the full quantity on my dilaudid supps. It's just so ridiculous that I have to expend the time, gas, energy, and money to go to two different pharmacies just to get my meds. I'm sure this policy is adversely affecting MANY others in the chronic pain community.

    I will definitely read the link that you posted regarding this policy. Maybe I'll even try writing to my congressperson. Thanks for your answer, Steve.

  4. #4
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    Pharmacist Steve Thank You. I had a problem with the clinic pharmacy NOT having my meds in stock. this has never happened before. I filled one for the IR and went to another for the ER. I know I broke a cardinal rule in going to another pharmacy, won't do that again - but was told I needed a pre-auth for my ER prescription. this was NEVER an issue at the clinic pharmacy - (medicaid) lately it is as I am tapering down, and they said at first that i cannot have both IR and ER Morphine. Also a limit on the number of pills. I finally got the pre-auth thru, after sitting on my NPR's head, and then my partner went thru the same thing. I do not believe the insurance plans have a Dr. on staff, all they do is look at numbers. At this point, I found a doc., Clinic that does Acupuncture, another things but we have to change our insurance plan, which is insanely complicated. in addition, the NPR, when my partner WAS on the insurance plan that this clinic takes, NEVER tried to help her/Us with alternative medicine, when this clinic has been around for years. finally, why can't I have a real Doctor, this NPR wants to do PM, she does not have a clue - she just writes scripts.
    This is BS.
    Blessings
    Alex44
    skypilot
    Last edited by alex44; 05-23-2014 at 11:35 PM.

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