Dr. Gonzalez: Many of the chain pharmacies have implemented policies relating to the know-your-customer policy of the Drug Enforcement Administration and many of the pharmacists are required now to document and corroborate information relating to the legitimacy of prescriptions for controlled substances that they receive in their pharmacies.
This may involve questions relating to, for example, diagnosis, long-term treatment plans, and other requests that encumber physicians who are very busy with their practices. That information eventually gets back to the wholesaler and to the DEA, as part of their due diligence in assuring that they know their customers. But it creates a burden, there’s no question. Everybody is getting strapped regarding time. There’s an issue with patients not getting their medication in a timely manner, if the pharmacist can’t get the information from the prescriber. Pharmacists may be filling 300 prescriptions a day, and clinicians have schedules to maintain.
Dr. Ziegler: In the big picture it may have been a good idea, but the way it was implemented became a problem. Prescribers and pharmacists have little time as it is, and for them to take away their time to engage in a national policy and doing it on each and every prescription creates a backlog. It creates a hostile environment between the prescriber and the pharmacist where it really should be a team effort. So these were some of the negative outcomes of a policy that was intended to do good.
Dr. Gonzalez: I have experience working for the medical board of California and we would get questions about how to improve the communications between health professionals? Just going into the pharmacy introducing yourself, giving them a business card, a phone number where they can call and guarantee the pharmacists that they will get that information that policy requires. Another thing I highly recommend is that prescribers put together some type of committee to discuss and agree on an appropriate treatment plan for difficult patient cases. They come to a consensus with a treatment plan that would be considered the standard in the community. Then they can go back to their offices and implement those treatment plans and feel comfortable with the fact that they can answer a knock on the door from regulatory if it comes.
Dr Ziegler: Pharmacists have a corresponding responsibility under the Controlled Substances Act, and they have the ability to not fill a prescription even though it’s been prescribed if it’s not consistent with the public health interest. But we would hope of course that both the prescriber and the pharmacist would be on the same team with the same goals.