Opioid settlements against pharmacies

Pharmacies have reached massive settlements in lawsuits against them. CVS and Walgreens, $5 billion each. Walmart, $3.1 billion.

I can’t understand the basis for the lawsuits. When a patient brings a legitimate, doctor-issued prescription into a pharmacy, isn’t the pharmacy legally obligated to fill it? Wouldn’t the pharmacy (and the pharmacist) be liable for damages if it refused to fill prescriptions, even if the pharmacist felt that the doctor was prescribing too much and/or the patient was not receiving the optimum prescription?

It seems to me that the pharmacies are in a “damned if you do, damned if you don’t” Catch-22.

The agreement with Walmart follows tentative deals announced this month by CVS and Walgreens, which are still being negotiated. If finalized, the total amount from the three giant pharmacy retailers would reach about $13.1 billion, including $400 million for Native American tribes.

The money from this and earlier settlements with pharmaceutical companies is expected to go toward drug treatment and education programs, to help communities combat a continuing addiction wave, now largely fueled by illegal fentanyl.

Of course, the fentanyl has nothing to do with the legal opioids sold by the pharmacies. According to a recent article, the latest deadly fad is mixing methamphetamine with fentanyl. There is no known treatment for meth addiction. Plus, meth is being made by a new chemical process that causes severe brain damage to users.

As a CVS shareholder, I’m annoyed that the pharmacies are being tapped for their deep pockets even though they aren’t to blame for the crisis.

Wendy

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Late last year, a jury in Cleveland found the pharmacies liable. With some 3000 open lawsuits, a settlement caps the damages and puts the issue behind them.

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"The Controlled Substances Act and applicable regulations impose the responsibility for the proper dispensing of controlled substances on the pharmacist. Pharmacists have a role in preventing prescription drug abuse, dubbed their “corresponding responsibility” in the Code of Federal Regulations. “The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.” 21 C.F.R. § 1306.04(a). Text is from: " Pharmacists Must Identify and Resolve Red Flags in Dispensing Controlled Substances, March 25, 2019

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I thought so too, but part of WalMart’s defense is that it had refused to fill over 100,000 “suspicious” prescriptions, and had disallowed some doctors from writing any prescriptions that they would fill. (That might also be why their settlement is less than either CVS or Walgreen’s, or perhaps they do less pharmacy business than those guys, dunno.)

Anyway, apparently there is some wiggle room in what pharmacies are allowed or not allowed to do. The lawsuits go after them, of course, because that’s where the money is; it would be infinitely more difficult to try to sue to various doctor/abusers to get recovery. That, sometimes unfortunately, is how the tort system works.

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The results, the deaths, the harms, the poverty were seen daily by the pharmacies. The studies were coming in.

The opioids are control substances. The pharmacies can not take such actions sheerly for profit. I am not expert on this but pharmacists have legally defined responsibilities between the pharmacy and the patient on allowing the opioid subscription to be filled.

Taking a profit off of the demise of patients…that really needs to be explained? It aint legitimately making a living. If this nation got off its high horse for the white collar crimes some executives should be up on third degree murder.

Families can legally crucify a corporation under two conditions, the injured party is white and the corporation made a profit in contributing to the harm of a family member.

Now I get a much more elegant lawyer can get on here and say that is all opinion blah blah blah…but that is reality. Those white families should hang them high. So should our brower families that for now is not reality. The difference here it became very political as the young dead white bodies mounted up.

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laffisloon,

Thanks for contributing that.

Goofy,

There is another behind the scenes factor that Walmart did not rebuke. The pharma companies can reward companies for selling more of their product. The rules on those rewards have shifted dramatically over the years. It is now much harder to legally reward people for ordering prescriptions or filling them but these cases predate most of the legal changes.

Were they?

As Wendy pointed out, the street drugs that are causing the harm…bootleg fentanyl and meth (not to mention heroin, ketamine, propofol and a host of other pharmaceuticals with a legit therapeutic use)… don’t get into the users’ hands via a prescription.

“Ah!” you might say, “but it’s the prescription medication that got the users hooked”. I suspect that even that isn’t quite the reality that many people believe…unless stealing granny’s tramadol that’s prescribed for her “…” (insert whatever painful chronic condition where you think an opioid might be the drug of choice) counts.

I’m not as up to date as I used to be on addiction stats when I was every once in a blue moon prescribing opioids and I’m not suggesting that the opioid epidemic is a myth but addiction is a multifactorial issue such that’s easy to identify a few high profile, deep pocket scapegoats. I’ll just point out that successful lawsuits don’t necessarily mean true culpability and I suspect that this latest round will serve the purpose of making useful painkillers harder to get for those who need them…and the addicts will find a source for their addiction regardless.

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My understanding is that a pharmacist can legally refuse a prescription if in the pharmacist’s opinion the drug is being abused or will cause harm to the patient. One obvious example would be if the prescribed drug has harmful interactions with another prescribed medication that was missed by the doctor.

Since the pharmacist has the right to refuse a prescription for safety concerns it appears that the courts believe this is a legal responsibility.

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I still can’t see that this obligation would be a legit grounds for lawsuit.

There’s a big difference between the pharmacy computer system flagging a potentially dangerous interaction and the pharmacist double checking with the prescribing physician and refusing to dispense a medication that that they (the pharmacist) deems to have been inappropriately prescribed or because it violates their beliefs…whether it’s pain medication or the morning after pill, etc

No VE,

What I am going to say is commit a wrong against someone else you face liability. As your mom and you said as a mom, “two wrongs do not make a right”. You are deflecting by bring up fentanyl.

Also the opioids involving oxy did come up first. The studies are simply the number of dead bodies as a result.

hey dont sell deadly crap to my family indiscriminately and expect no liability. My family actually has had no one close to any of this. Just saying.

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the addicts with prescriptions from often retired hack doctors were hitting the pharmacies nonstop. The patient pattern was easy to spot. That sort of addiction pattern is under the umbrella for refusing to fill a prescription…particularly for a controlled substance, opioids.

It is the frequency of all opioid sales–and the volume issued by just a few doctors. Every now and then (i.e. 2-3 Rx of 5 pills in 10 years), one of my doctors issues a prescription to my pharmacy for oxycodone or similar (just got such an Rx in Jan 2022). I get it (delivered to me)–but I don’t take it because I don’t need it. Not an issue because volume is low and infrequent (for the doctor, pharmacist, AND me).

Now change the numbers to 4 Rx/yr times times 120 pills/month (“take 4/day as needed for pain”) times 3 months (90 days) times multiple doctors (“pill mill”) and multiple pharmacies (patients use multiple IDs–or not, especially if the pharmacist is “in” on what is going on and profits–directly or indirectly).

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@VeeEnn you are slightly behind the times.

CDC did indeed issue orders to doctors to withhold opioid pain meds from patients with severe chronic pain, starting in about 2016. The result was so disastrous – cancer and other chronic patients in terrible pain, some so much that they took illegal heroin and died of overdoses – that the CDC recently rescinded the order by issuing new guidelines, just a couple of weeks ago.

Wendy

I mentioned specifically fentanyl and meth as an answer to Wendy…no deflection at all. The use of illegally obtained street drugs are currently fueling the addiction and overdose epidemic. You’d be pretty hard pressed to find figures supporting your assertion that the folk who’re on the receiving end of this supply chain started off as legitimate users of legally prescribed pain meds.

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You’re conjuring up an imaginary/illegal scenario here.

There are, in fact, restrictions on prescribing controlled substances (and have been for a while) such that getting a regular high dose supply…like someone might with insulin, say…via repeat prescription isn’t actually possible without a huge conspiracy between gawd knows how many conspirators. Yes, I know everyone likes to be “in” on knowing about these conspiracies but I’ve spent a lot of time wondering (in a totally academic way, you understand)how to do it without getting caught and can’t work it out. People do get caught…that’s how you know illegal stuff does happen, when it’s reported on…because there’s a paper trail.

Here’s a random example about the likely culpability of your average pharmacist. Years ago…before Vicodin had it’s designation reassigned to a Schedule II drug, I got a phone call from a pharmacist who didn’t know me asking if I’d called in a prescription for 100 Vicodin tabs. You should be aware that, back then, it was possible to do that for a limited number and follow up with the actual written prescription…nowhere near 100. Naturally, it was an effort to obtain Vicodin illegally. My accent is distinctively still English so pharmacist realised it wasn’t me who called even though the caller used my DEA number. We came to the conclusion in the practice that the info used came from a written prescription (would be either antibiotics or fluoride as I hadn’t issued a prescription for an opioid in a few years) that some miscreant had tried to use knowing that a phone call might do the job but…but not knowledgeable enough about prescribing regulations to realise she’d got it wrong. I called the pharmacist a week later and no one had been to pick up the prescription.

Me, I reckon folk who receive regular prescriptions for opioids they don’t need/don’t use (for personal pain relief) are as much part of the problem as the imaginary situation you describe.

Actually, Wendy, the pendulum swung towards physicians under prescribing appropriate pain medication before any regulations kicked in…and no doubt won’t swing to an appropriate level any time soon. Primarily because of the epidemic of reporting surrounding the emerging opioid abuse crisis, I reckon and the frequent stories of folk descending into an addiction spiral because of a first encounter with a prescribed medication. I seem to recall Jamie Lee Curtis blaming her years of abuse on pains meds prescribed after blepharoplasty Now, that might be true…but, if so, that’d be a very idiosyncratic response.

Not to say that all blame should be heaped on the drug abusers themselves (as I mentioned upstream, addiction of any kind is a multifactorial problem) and I certainly don’t feel kindly towards Perdue and other guilty parties in the pharm industry for misrepresenting the addiction potential of, say, OxyContin. It’s still hard to fathom exactly how these pharmacies are supposed to be liable for the illegal behaviour of others

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Are pharmacists required to double check questionable scripts with the prescribing Dr?
If so, then, I too don’t see how the pharmacy is liable.

Wouldn’t this push the liability back onto the prescribing Dr?

:alien:
ralph

Not if they are working together to milk the system for $$$.

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That was in the context of a computer programme flagging a potential drug interaction…like, say, drugs that might interfere with something like warfarin that’d be a bit dodgy if not closely monitored (and the pharmacist might have no idea if the INR is being frequently checked and doesn’t trust the customer’s understanding)

This is totally different from needing to act like the Opioid Police…which I don’t doubt that some might think is their job…especially since the scenarios that folk seem to imagine happening on a regular basis don’t.

For example, when I had the bunion surgery, all my orthopedist’s post op info stated that he would issue a prescription for 30 oxycodone (5mg) and Tylenol tablets and no more. Now, not knowing much about bunion surgery but plenty about the post op pain with any orthopedic intervention, I thought this was a bit parsimonious. I picked them up ahead of time and followed all post op instructions except that I foundnby accident that I must be a slow metaboliser or something because just 3 a day kept me comfortable. At suture removal just over a week later, he asked if I needed a repeat prescription. I was able to decline (but, as it turned out could’ve done with a couple of day’s more) and he mentioned that the “one prescription only” was just a response to the popular perception in the minds of folk who’re pain free that doctors prescribe opioids willy nilly. You need to be reasonably pain free to heal properly

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I believe pharmacies become liable when they have evidence of questionable prescriptions and fail to take action, such as double-checking with the doctor.

It is worth noting that as part of its defense Walmart said that its pharmacists had refused hundreds of thousands of opioid prescriptions deemed problematic and blocked thousands of doctors identified as questionable from having their opioid prescriptions fulfilled.

This is (a bit ironically) an implicit admission that pharmacies actually do have a responsibility to question and even reject problematic prescriptions from legitimate doctors. Apparently, a federal jury found enough evidence to conclude that the pharmacies didn’t do enough such actions with respect to opioids.

I can imagine circumstances where the evidence of opioid mismanagement/abuse by either the doctor or patient is sufficiently obvious that the pharmacy has a legal responsibility to take action. The question is whether such circumstances occurred and if they did whether the pharmacies routinely failed to act responsibly. Can’t have a legitimate opinion on that without knowledge of the details of the case.

On a related note, in 2020 the DOJ charged Walmart with among other things:

“…filling thousands of invalid prescriptions at its pharmacies and failing to report suspicious orders of opioids and other drugs placed by those pharmacies…” Department of Justice Files Nationwide Lawsuit Against Walmart Inc. for Controlled Substances Act Violations | OPA | Department of Justice

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