As I thought -

[kyburg]

usafpa pointed this out this morning:

AMA: Physicians Charge Pharmacists With Interference in Medical Care


By Peggy Peck, Senior Editor, MedPage Today
June 20, 2005


CHICAGO, June 20-The American Medical Association's policy-making body voted today to press for state laws that would allow physicians to dispense medications when there is no nearby pharmacist willing to dispense the prescribed drugs.

The new AMA policy is an attempt to overcome what doctors say is a stampede of pharamacists who say they cannot in good conscience dispense certain medications. The issue of conscientious refusal was first raised when some pharmacists refused to fill prescriptions for the emergency contraception pill, called Plan B. Additionally some pharmacists refused to fill prescriptions for birth control pills.

But AMA delegates say the conscience-based refusals have now spread to psychotropic drugs and pain medications.

The new AMA policy states that doctors should be allowed to dispense medications when there is no "willing pharmacist available within a 30 mile radius." That change would require change in state laws regulating both doctors and pharmacists.

The AMA House of Delegates' action went beyond initiatives that had been discussed at reference committee hearings.

The doctors say that many pharmacists compound their refusal to fill prescriptions by not returning the unfilled prescriptions to patients, thereby stymieing efforts to turn to other pharmacists.

"It's not just contraceptives," said Mary Frank, M.D., a family physician from Mill Valley, Calif., during a discussion of the issue. "It's pain medications and psychotropics. And not only are the patients not getting prescriptions filled, but pharmacists are refusing to return the prescriptions and they are lecturing the patients about the drugs."

In response a coalition of medical specialty groups including the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women's Association, and the Michigan State Medical Society is asking the AMA to press pharmacists to follow ethical guidelines for delivery of healthcare.

The American Pharmacists Association has policy that recognizes an individual pharmacist's right to exercise conscientious refusal and "supports the establishment of systems to ensure patient's access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal."

Physicians say that language means that pharmacists must "refer patients to other pharmacists who are willing to fill the prescriptions" just as doctors are ethically required to refer patients they are unwilling to treat, said William Golden, M.D., a Little Rock Ark., internist. Dr. Golden pressed the case for AMA action Sunday during a reference committee hearing on the issue.

Several physicians testified that conscientious objection first became an issue with contraceptive prescriptions, especially prescriptions for emergency contraception; the so-called morning after pill called Plan B. But now, they said, the phenomenon has now expanded well beyond contraceptives.

And doctors say that pharmacists are winning support in state houses with 14 states already considering legislation aimed at protecting pharmacists' right to refuse to fill prescriptions based on religious, personal or moral grounds and nine more states in the process of enacting legislation that would allow pharmacists to refuse prescriptions "for any reason."

The AMA House of Delegates, the organization's policy-making body, is expected to vote today on a series of proposals that would require the AMA to mount a lobbying effort to "guarantee patients' access to legally prescribed and medically indicated therapy."

The American Pharmacists Association did not respond directly to the doctors' concerns. Kristina Lunner, director of federal government affairs, said the organization has received no complaints about pharmacists refusing to refer patients or refusing to return prescriptions that the pharamacist refuses to fill.

In a statement issued several weeks ago, however, in response to a critical editorial in The New York Times, the pharmacists' group said:

"Pharmacists, like physicians and nurses, should not be required to engage in activity to which they object. But supporting a pharmacist’s ability to step away from objectionable situations does not require a confrontation with the patient...

"Our organizations support the two-part policy stressing the need to assure patient access to legally prescribed, clinically appropriate therapy in a timely manner when a pharmacist steps away from working with a prescription based on personal beliefs. Pharmacists must not use their position to berate, belittle or lecture their patients -- our organizations oppose such action. Pharmacists must not obstruct patient access to therapy -- our organizations oppose such activity."

Ms. Lunner said pharmacists' organization has no mechanism to censure pharmacists who refuse to refer patients or refuse to return any prescriptions that the pharmacist concientiously objects to filling. She said such complaints are referred to the state licensing board.

That's right - each state licenses its own pharmacists.

Do you know who you're gonna call?

This is the list of applications you need licensure for in pharmacology in California. Wow, look at how many ways you have to be licensed in California, you deal with drugs - who ya gonna call? Board of Pharmacy, 400 R Street, Suite 4070, Sacramento, CA 95814; (916) 445-5014.

Less than 30 second Google.

Oh, and send a nasty gram to that nice Pharmacists organization too. Just to keep them in the loop.

Comments

[lesliepear.livejournal.com]

Argh.

As a user of thyroid hormone this concerns me - as pharmicist have pushed the generic levothyroid to fill prescriptions as being the same as synthroid. It is not and lacks consistancy. Although I can't imagine someone objecting to dispensing thyroid hormone or a certain one - pharamcists should fill what is given and if they can't deal with it, don't be a pharamcist or work somewhere where you won't see those prescriptions ever.

[kiyone.livejournal.com]

Actually...

Having to deal with this situation on a daily basis, I can assure you it's just not the pharmacy randomly choosing to punish you with the generic form of a medication.

Rule number one: The pharmacy will ALWAYS fill a medication with the generic if one is available unless specifically requested. Always. They have signs all over that say they will. Just expect it.

The honest truth is that generics are less expensive. Chemically most, if not always, they are created with the same active ingredients that your typical brand-name medication is except for a filler - and in your case I have heard of this complaint about L-Thyroxine or Levothyroid. And there's also the fact that some medications don't disolve the same when made with the different fillers/work in the same fashion. But I'm not a pharmacist, this is just what I've heard from the ones I work with.

Working in customer service in ordering hundreds of perscriptions for people on a daily basis, I have learned:

A) It's not the pharmacy a lot of the time, it's actually the health plan. Some insurance companies will REFUSE to cover the cost of the medication if there is a generic equivilant available.

B) In other health plans, there's a penalty to have the brand over the readily available generic, this is called MAC pricing where they will charge you the cost of the generic (whatever your copay is) plus the DIFFERENCE between that and the brand. Again, this is the insurance company and what they decide they will cover. Some insurance companies won't cover allergy medication. Or birth control. Doesn't mean the person can't buy it, it just means they gotta pay full price.

There are ways around it, of course. EVERY single time you get a perscription, the best way to resolve this is have the Doctor write it as "DAW" or dispense as written. You will get into a lot less arguments, because the perscription is a legal document and it cannot be altered. The only reason anything is changed (such as what is dispensed/qty or medication) is because of the insurance plan and what it will cover. Sometimes some insurance plans have a benefit where you will actually only pay the standard brand copayment (instead of brand when a generic is available copayment) because the Doctor SPECIFICALLY requested it. It's very important to know that about your plan.

I'm sure you already know a lot of this, but there's also taking responsibility for your own actions. The doctor works for you. If the doctor doesn't DAW it when you request it, he may feel that the generic is fine for you as well. At that point, you can always specifically state to the pharmacist with a post-it on the perscription stating you want it DAW'd. They also have to listen to you.

And yeah, sometimes there are just brand specific people who will complain they got the generic and it doesn't work the same when, in fact, we dispensed the BRAND and they just didn't like the generic name on their bottle (when a generic isn't available to dispense, but the pharmacy should have it - we'll dipsense the brand and charge the generic pricing, putting in lovely ()'s the actual name of the med). I've heard stories of people not liking a generic med and stating it didn't work because it didn't have a nice smooth candy coating to help it go down. Once the generic manufacterer fixed that, those 'non-working' complaints went away. My personal favorite is that a lot of generic meds are, in fact, actually made by the manufacterer of the brand just under a different name and sub-company division. The more you know.

[caitlin.livejournal.com]

Y'know, I remember "back in the day" when everyone didn't have to worry about "possibly offending" someone... rather than these days when even the POSSIBILITY of offending ONE person starts a lawsuit or something.

And pharmacists didn't preach morality at women getting birth control pills for whatever PERSONAL AND PRIVATE reasons they may have. And I hadn't heard about the pain med thing now too. *sigh*

Did you catch the fact that a Republican Congressman screamed at the Democrats who were objecting to something the Republicans were trying to do by saying they were "demonizing Christianity"? *headdesk*

Everything's just gotten really out of hand.

Where did the sanity go?

C.

[kyburg.livejournal.com]

It went away when people decided Rush Limbaugh and Ann Coulter were "funny."

[caitlin.livejournal.com]

I never found Rush Limbaugh or Ann Coulter "funny".

Al Franken, on the other hand... *g*

That's another story.

C.

[joggingguy.livejournal.com]

Found an interesting comment here

The American Medical Association has decided to challenge these pharmacist refusal clauses, that allows pharmacists to turn away women trying to have their contraception prescriptions refilled. Then these pharmacists go on the merry little way to refill Viagra, Cialis, and Levitra prescriptions without any “moral objections.”

[fallofrain.livejournal.com]

WHAT?!? Last I checked Pharmacists weren't doctors! Who do they think they are lecturing anyone on what kind of medication a doctor has prescribed to them... oh that makes me so angry. >(

[kyburg.livejournal.com]

Careful - most pharmacy programs approach a physician's in length, breadth and experience required, let alone licensure.

However, this is one of those professions that works in tandem with another professional, and the relationship is definitely inferior to a physician who writes order for the pharmacist to fill. You can question; you can't refuse. You want to do that, you need to find another job.

[lolleeroberts.livejournal.com]

Pharmacy is a 5 year degree, much like engineering. Most pharmacists have a Bachelor's degree. While I wouldn't say they were inferior to doctors, unless you have a Doctorate of Pharmacy you aren't at the same level as a physician who's had 4 years of undergraduate, 4 years of graduate(medical) school and 1 to 6 years of residency training.

I want to know why people who have that many objections to the use of medications for various problems go into pharmacy at all. Could it possibly be just so they can screw around with people and go on little power trips?

[fufaraw]

Unfortunately I have no statistics to back this up, but it appears, and enough incidents are being reported from widely-scattered sources to suggest that zealots are going into the profession of pharmacist precisely in order to wage guerilla war on peoples' rights to the medications their physicians prescribe. Further, some physicians are also, on religious and moral grounds refusing to prescribe medications that are most effective in treating medical problems or conditions.

Rather than upholding and making lawful a professional person's right to discriminate against a drug or class of drugs on religious or moral grounds, I would think the government and/or professional organisations would take steps to insure that people going into these professions either have no religious or moral prejudices to begin with, or take oaths that such prejudices or objections will not interfere with the performance of their profession. And that should, at some future date, they be unable to perform their professional duties due to religious or moral objections, they be required to leave and not practice their profession, rather than practice some selective and abbreviated version of it.

But then, that would be rational and logical. And would also prevent religious sabotage of the public's rights to the best possible treatment under any circumstances.

[kyburg.livejournal.com]

You know, I don't think I has as much objection to the doctor's not writing the prescriptions - but then again, I'm aware, informed and use my doctor's time as a consultant on my case, not the patriarch of my well-being.

If he/she doesn't want to prescribe something, I'd likely notice it and question it.

"Really? Arsenic is bad, huh? Okay. Now, about this marijuana you don't want to prescribe...let's talk."

Anyone who didn't want to work with me to resolve an issue? I'm gone - and I can find someone else. I know I can.

I like that

[turandot.livejournal.com]

After all, lawyers are required to maintain a certain level of ethics, and if they lied in order to be admitted to the BAR, their license is revoked. Moreover, certain public servant jobs require levels of clearance in order for someone to have access to the position. Why shouldn't there be something comparable to either for doctors and pharmacists? =/

[inagawayuu.livejournal.com]

There are already doctors here who are giving out certian medications like birth control directly to the paitents insead of giving them perscriptions. I don't know about other states, but here it's legal for doctors to give out samples of drugs, so they are allowed to stock them in-office. Many of them now give 'samples' which just happen to be 6-month supplies of birth control.

They can't charge the paitents for the drugs, but many doctors are eating the costs just so they know their paitents can get these drugs and as their way of protesting our state law which allows pharmacists to deny medicine and not give the percription back.

I had one of my doctor's give me 6-month supplies of Depakote (for my depression/manic disorder) because for some reason, a lot of pharmacies here don't stock it. Quite a few pharmacies here now don't stock many of the psychotropics except for Prozac, Zoloft and their generics, and if you need anything else, you have to get them special ordered.

My brother is a Pharmacist (and a Born Again Christian), and hubby used to work for one, and they both are appaled by how much power Pharmacists have over people's health, and want these 'denial' laws gone from the books.

[dwinghy.livejournal.com]

So, they won't fill out birth control, pain relief, or psychotropic prescriptions... what the hell are these guys doing all day? Painting their nails and reading romance magazines? I can't decide if they're idiots pushing a political agenda at their place of work or simply the laziest things ever.

Seriously, if they voluntary became pharmacists knowing full well the job would be more than handing people anti-biotics, they have NO BUSINESS trying to cop the "conscientious objector" plea. It's bullshit.

[lysana.livejournal.com]

Psychotropics? Are Scientologists getting in on the act now, too?