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Value Your Privacy? Avoid Walgreens Pharmacy

Posted 05/20/2013

One evening a couple of weeks ago while at a movie I felt my cell phone vibrate. This was unusual, since virtually all my patients correspond via my often-checked e-mail. The caller ID was unknown to me, and was not that of my answering service. I would have waited 15 minutes until the movie ended, but there it was, vibrating again. And so, muttering to my wife “Tell me how this ends,” I headed for the lobby.

The caller was a pharmacist from Walgreens.  She inquired if I knew a certain Ms X, naming one of my longtime patients. I told her I did and asked what the problem was.

“Did you write her a prescription on (a date two days earlier) for (a common pain medication)?”

I thought to myself, “What a question! I write anywhere up to 50 prescriptions a day and she thinks I’m going to remember the specifics of one from two days ago.” However, I knew the patient well, and knew her meds, so I confirmed the prescription as mine. “Thank you,” she said, “Just checking.”

But after I hung up, I went into a slow boil. The call was totally unnecessary and wasted everyone’s time, especially the patient’s, who was waiting for her prescription to be filled. What is it with some pharmacists making a criminal of every customer who hands them a prescription for a controlled drug? An experienced pharmacist can spot prescription fraud a mile away. And if she’s in doubt, she can simply hand back the prescription with a “Sorry, I can’t fill this.”

The pharmacist who had me paged apparently needed a character reference on her customer before filling the prescription. Had she bothered to check her records, she would have discovered the woman was indeed a regular customer and that this was an ongoing medication for her. If the pharmacist was suspicious, the State of Illinois maintains a helpful prescription monitoring website for health professionals that keeps tabs on the use of controlled medication (opioids, amphetamines, anti-anxiety meds, sleeping pills) by everyone in Illinois. In about ten seconds, by clicking through the website, the pharmacist could have discovered that her customer used this medication regularly, had just one prescribing physician (me), and refilled her meds at appropriate intervals.

Disturbing fax from Walgreens
I would have chalked up this phone call to a newbie pharmacist had I not received a most disturbing fax from Walgreens a couple of weeks later. Just a few quotes and comments will give you the gist. Remember, this letter is being addressed to prescribing physicians (emphasis mine):

“Many of you have raised concerns about the confidential or private nature of your patients’ health information. By law, pharmacists are granted access to private health information necessary for them to perform their responsibilities.”  (My comment: this is a VERY loose interpretation of the existing laws.)

“Under Federal regulation, pharmacists have a responsibility 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 the patient diagnosis and expected length of therapy. We understand this diligence takes extra time, for our patients, and for you, our partnering physicians. We want to thank you for taking this time…”

Your initial response might be: Well, there are some bad characters out there. Dope dealers and such. I can see why a pharmacist might want to call my doctor and check on this before he hands over a bottle of OxyContin.

To which I answer: If you agree with Walgreens, kiss your privacy adieu. Believe me, no one in health care–not WholeHealth Chicago, not Rush, not Northwestern–runs a caller ID on every incoming call. I’m not at all suggesting you try this, but were you to have a friend call your doctor’s office and say, “Hi, this is William Jones from Walgreens. We’re just checking on your patient (insert your name). Did the doctor prescribe (name a med you take)?” you’ll be horrified how quickly your privacy barrier is transcended.

In actual fact, given the vast numbers of controlled medications in use, the percentage of prescription drug abuse is extremely small. One study on opioid analgesics–OxyContin and the like–pegged “inappropriate use” (addiction, re-selling drugs) at less than 1%. It’s also true that abuse of prescription narcotics is epidemic, but when a pharmacist knows her customer base and uses the prescription monitoring website described above, there is virtually no justification for calling a physician or manipulating HIPAA (privacy) health care laws to probe into a customer’s personal medical records.

Walgreens’ master plan?
So I had to ask myself: what could be the real reason for instituting a policy that is guaranteed to get pushback from both customers and their physicians? I think there are two factors at play.

First, the economics. It always boils down to economics. Having been raised in a drugstore myself, I know controlled drugs are a real pain (pun intended). They require meticulous record-keeping by both physician office and pharmacy and are the first targets of burglaries and employee theft. Also, since most of the better pain medications are still brand-name, maintaining inventory is quite expensive and the profit margin is very low.

When a store fails to maintain proper surveillance on its controlled drugs, the fines are substantial. All in all, with lots of work and little profit to show for it, Walgreens probably wishes controlled drugs would just go away. Let CVS have the business. A steady decline in controlled drug use is distinctly possible with Walgreen’s new approach. If physicians are badgered at all hours by “concerned” pharmacists, they’ll just write as few controlled prescriptions as possible.

Second, Walgreens’ ambitions to enter all aspects of health care make privacy irrelevant. Once the Affordable Care Act is in place, Walgreens will enter the fray and start selling health insurance. They already operate hundreds of Take Care Clinics, which are poised to convert to primary care offices. Last week, it was announced these clinics will start treating chronic illnesses (blood pressure, diabetes, etc). With all the pieces in place—insurance, primary care offices, and pharmacy services–Walgreens becomes your total health care provider, fully entitled to access all your medical records.

Now envision that nice young person totaling up your purchases at Walgreens, first asking “paper or plastic?” for your cigarettes, Altoids, Tampax, Jack Daniel’s, and Reese’s Pieces. Then, with a smile and a quick flick on her screen, she cheerily asks if your herpes flare-up has cleared while printing a quick discount coupon for your overdue Pap smear. Behind you in line, a curious seven-year-old asks his brother in a too-loud voice, “WHAT’S A PAP SMEAR?”

But seriously, Walgreens’ aggressive invasion of your privacy is not at all amusing. Let me end this with a most disturbing clip from the 1999 film Magnolia. By way of background, Julianne Moore plays a young wife caring for her much older husband who’s at home dying of cancer. She is utterly exhausted and on the verge of a meltdown. The clip picks up as she stops at the pharmacy to get her husband’s pain meds and her own antidepressants.

Based on the fax I received, the only thing this scene lacks is the Walgreens sign in the window. Watch carefully as the senior pharmacist dials his phone—that’s the call Walgreens wants doctors to expect. That’s the future. And I warn you, the next three minutes are deeply unsettling.

If you’d like to share a pharmacy experience with other readers, please do so in comments below. Meanwhile, Walgreens management may want to go back to the drawing board on their motto “At the Corner of Happy & Healthy.” It’s one of those res ipsa loquitur moments.

Be well,
David Edelberg, MD


Posted in Blog, Knowledge Base, P Tagged with: ,
6 comments on “Value Your Privacy? Avoid Walgreens Pharmacy
  1. John Rae says:

    Seems to me Walgreens is on a crusade to end drug abuse which is fine but everyone is guilty. Why don’t they just not fill controlled substance. Oh wait they do it with over the counter medicine too. They told me that it was illegal for my double board certified doctor to write me a script for Ritalin.

  2. Sandra Gaughan says:

    I had bad experiences at walgreens when it came to filling my pain meds. I bet the call was about me I would:nt be surprised! It was wrong 4 them to call U. That way. Dr. Edelberg please write me back I really need to talk to you about all this & my pain med prescriptions, how they label U. I loved your comments sincerely your long time patient

  3. Millie says:

    Pharmacists are part of the healthcare team and many of my patients do not have a PCP they see regularly and rely on me for their healthcare needs. We are usually the first line of defense when it comes to important health related issues such as the flu and bug bites as well as prevention of something as trivial as torsade de points and death in your cardiac, arrhythmic and anti-coagulated with Coumadin patient who was prescibed a Z-pack by on-call physician Dr XYZ.

    (By the way, your phone not blasting 90 times that Saturday evening during your movie? Attribute that to your local Walgreens pharmacist this flu season – they’re the ones taking those calls for you.)

    As stated above, pharmacists are part of the healthcare team and should be treated as such. When a pharmacist calls you to verify the diagnosis of the controlled medication you are prescribing, that is a legitimate and valid question. By ensuring we have a valid diagnosis listed on the prescription, this can prevent us from ever calling you again regarding this patient. If you do not want to receive this call, it would be very helpful if the diagnosis was already listed on the prescription.

    Another point I would like to make is the US government runs on checks and balances. So does our healthcare system. Unfortunately, we live in very bad times my friend and I personally have come across countless number of physicians that have had their licenses revoked as well as many pharmacies (including a CVS) that is under strict observation from the DEA and can only accept control medications from a limited amount of physicians (3 to be exact in the case of that CVS).

    Stating that – I would like to add something very imperative to my discussion: we WANT to treat our patients. What we do NOT want is for our severely miserable patient suffering from severe lumbar disc herniations or malignant neoplasms to be under-treated. And if you buy nothing else in this dissertation, believe this, we HATE playing cops and robbers. Hate it with a passion. Hate it. Hate it. Hate it. Hate it. Hate it. We did not go to school for 8 years and earn our doctorate degree to play cops and robbers. The amount of mental anguish this causes is astounding. It takes up MY valuable time and energy when I have to call a physician to verify a fraudulent prescription from a stolen RX pad. In this scenario, I can also do one of two things. I can easily tell the patient, I will not fill it and have them be on their merry way to fill at another pharmacy without ever calling you to let you know that a patient of yours has stolen an RX pad and has possibly distributed it to anyone he or she feels fit. I can also just as easily look the other way and fill the prescription so that a nice and pleasant drug dealer can meet his/her quota for the month. But I don’t. I can’t tell you the number of grateful physicians that have thanked me for letting them know about their stolen RX pads or the ex-employee who has been calling in controls under their DEA number.

    I understand that you are annoyed by these calls, but when a new patient comes to the pharmacy with signs of a fraudulent prescription and no prior history with Walgreens and probably under a fabricated name so that the helpful prescription monitoring website you speak of is rendered useless – we double-check. Another reason we double-check is so that we DON’T turn away a valid prescription for a patient that truly does need it without verifying the validity of the prescription first.

    Another point noted by you was regarding privacy. HIPPA states that healthcare employees enlisted in the care of a mutual patient are covered entities. So by default, I have rights. You challenge that anyone can easily call you stating they are Walgreens pharmacists and get confidential information out of you. That assumption is just as absurd as me stating that someone portraying themselves as a nurse from a doctor’s office can call me to get information regarding medications that a previous physician prescribed – when they shouldn’t be. This is a two-way street. This privacy barrier that you speak of is transcended the minute a nurse from your office calls me to see what prescriptions her ex-husband is taking since “he is transitioning over to our practice now.”

    I can assure you Dr Edelberg, I speak for the majority of pharmacists when I say we are not your enemy. Whatever conspiracy you speak of is just that – a conspiracy. With all due respect, you really should re-evaluate your stance on well-rounded patient care, my friend. Healthcare can only progress when healthcare professionals work together side-by-side. The longer you stay in denial and keep pharmacists at a mental distance, the longer your patients and practice will stay at a disadvantage.

  4. Denise says:

    Thank you, Dr. Edelberg for this article. I recently had a pharmacist call my physician to discuss my anticoagulation therapy and I cannot understand why. The doctor did not send an order to change my meds and I did not present with a prescription. So, when I returned from vacation to have my meds refilled, I found out that the pharmacist had contacted my physician (unbeknowst to me) and had me switched from Xarelto to Lovenox. I was very angry. I had been on the Lovenox for years and my Hem/Onc doctor and I, after much discussion, switched me to the new med. This led to a lot of confusion b/w me and my physician, but we were able to resolve it. Since when does a pharmacist play doctor? I am completely OK with a pharmacist consulting with a physician about an order and understand they are a member of the team, but I don’t need an unknown third party making unwarranted inquiries into my medical condition for no reason. I have been going to Walgreen’s for years, but this particular pharmacist is rude, arrogant and crossed a line. I tried to sort this out amicably, but I don’t think Walgreen’s understands the meaning of the word…only legal action, fines or penalties.

  5. Susan Bennett says:

    My husband is a pharmacist and you are absolutely right. They are now required also to call their customers to discuss their compliance with taking their drugs, asking them about thier lab work, etc. Please know this is not just Walgreens. If a pharmacist called me I would firmly say “none of your business” This is a huge violation of HIPPA and someone needs to stop it if it has not already gotten out of hand. I would not even know who I was talking to. Please keep warning others and run ads in AARP. You do not have to talk to your pharmacist about your medical matters unless you choose to.

  6. Susan Bennett says:

    OH In response to Millie. It is not absurd saying I would not even know who I was talking to. I did not initiate the call as I do with my physician and know they will be calling me. The pharmacist calling you does not even know you. And commenting on your concern that a patient is being under treated is not your decision. A recommendation your customer speak with their physician treating them is far more appropriate than you diagnosing and trying to treat them. I don’t think a pharmacy license allows you to diagnose disease.

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