Can a pharmacist ask what your diagnosis is and say she won't fill script until doctor calls and tells her the diagnosis and why you take the medication. It was for 90 vicodin Es that aren't abused and only prescribed by one pain management doctor. Isn't there some privacy law and its none of the pharmacists business it the doctors?
Can a pharmacist ask for a diagnosis and refuse to fill prescription?
Question posted by Zappajvp on 20 April 2013
Last updated on 23 June 2022
The information on this page reflects personal experiences shared by our community members. It is not reviewed for medical accuracy and should not replace professional medical advice.
33 Answers Page 2
Dbstmsl2
22 Dec 2017
I believe a pharmacist should do their job and that is to fill medication! A valid script and insurance is all the pharmacist needs. Do not profile a customer. A pharmacist should not call your ex pain management doctor and ask why the customer was discharged! And then right in front of the pharmacy where other customers await their meds to be filled tells the customer I can't fill your medication you were discharged from Pain Management. Okay none of nobody's business but me and my ex PM. Now this is a new pain management doc do yr job and fill the meds. No you were discharged from last PM I can't fill ever for you. Basically calling me out as a druggie. I think I want to file a lawsuit. I was so embarrassed in front of staff n customers.
mets231
20 April 2017
I feel it is none of the pharmacy's business. Just do your job and fill the written prescription.
By them asking , it's like saying the doctor is wrong writing it.
If the pharmacist has a problem with a legit prescription and a legit Doctor writing the prescription then they need to call the doctor and argue with him or her.
My doctor faxed my diagnoses right over to the pharmacy before they even asked.
They are all over pain medication, but not alcohol. Buy all the alcohol you want...
openminded26
6 June 2017
everyone that works in the pharmacy has strict rules they have to follow. the federal government is so strict and make them do certain things. 1st asking about medical conditions help them know if something can not be taken due to that condition, and if anything happens while they are at the pharmacy they know what guidelines need to be taken for there safety and yours. they never know if its real or not and doctor offices fax sketchy things over or thing that so far unreadable or do not make sense. they can never assume. and they are not on pain med the government is, they dont have control over that, and 99% its insurance that wants to talk to the doctor as well. anything in the medical field has HIPPA!
Rosie61
11 May 2016
I find pharmacists often provide no privacy or dignity. They seem to resent being asked questions as well. They may know more about pills but if they want to get into diagnosing illness, become a doctor. I do not want to discuss my illness in a line up, in a small town, with a loud voiced pharmacist, or better yet, pharmacist assistant announcing to the building what my illness or condition is. And I don't care if that illness is a cold, cancer, an STD or whatever, I want my privacy and I don't get it in a drugstore. They can call the doctor if they need to confirm a prescription, they don't need to humiliate people. The reason so many people think all they do is count pills is because they so rarely get any meaningful help.
Inactive
3 Aug 2016
When you are saying the pharmacist should call the "Doctor" about a prescription related question, I am assuming you are referring to an MD or a DO? Pharmacist are doctors,not physicians, but pharmacists nowadays earn a doctorate, and spend just as much time in school as a medical doctor who earns their degree. Also, let's not forget that you do not have to go to medical school only in order to prescribe medications. At least 50% of scripts are written by either nurses (ARNPs) or a PA (physicians assistant). Bottom line is yes pharmacists do care about patients and it is their right to do their job and ask questions whenever necessary, just like any provider who writes you the script! Pharmacists are licensed health care professionals. The increased stress and workload for community/retail pharmacists however may explain their little time to spend with individual patients and your sense of lack in privacy. Pharmacists, as any other healthcare professionals are bound by HIPAA to not share any confidential information about patients.
agitated consumer
21 July 2017
I agree that a drug store pharmacy does not provide the privacy that really should be there. And to the person that responded to this and questioned what the person above meant by doctor: I believe, like most other people would, that the person is referring to the prescriber of the medication. Many common people would refer to the prescriber of the medication as their doctor. Apparently that person just wanted to play devil's advocate to help prove their point or make the other person feel smaller.
I am 60 years old, was rear-ended by an 18 year old girl 7 years ago, had surgeries, and have permanent damage and chronic pain. I could be on disability and stay home but I find with a few meds I can get through the day at work and lead a fairly normal, contributing life. I have had my prescriptions filled for several years at this same pharmacy. and for the first time in my life I was asked by a pharmacist, (I had never seen this pharmacist there before - perhaps he only works weekends?), 'what are you taking this for?'. I considered it an invasion of my privacy. There were people standing about 7-8 feet behind me and to answer the pharmacist they would hear me. I want my privacy! I also trust my doctor who I have been seeing for many years and knows my history. I also don't believe that because of a few doctors that write scripts for anyone for cash, that the people taking the meds legitimately should be harassed. Punish the guilty, not the innocent! The pharmacist could have checked my history and seen that I had had these filled there before (and these are not mega-quantities I am taking). And you know, I think if the pharmacist wants to question someone, question the doctors that wrote the prescription. If a doctor is writing too many prescriptions for pain/opiods, let them be investigated. Also, if pharmacies were so concerned about patients and not their own a&&es, they wouldn't hand out all the disclaimers and med usage instructions on 8 pages of type in small font stapled to the bag of meds that would take an hour to read. Do they really think many people read these? I'll bet most people rip open the bag and throw the rest away. They don't even put the warning stickers on the bottles any more. How safe is that? If you don't keep the 8 pages of small font with the package, you lose any warnings that should accompany the medicine. Ridiculous! Sorry, but I believe it's the pharmacies just trying to cover their a&&es.
Just to finish it off in case anyone is interested at this point (I know I've been 'preaching'), I can walk, but my wife has to do the heavy lifting at our house and in stores, which makes me feel bad enough, but now I feel a pharmacist is questioning me and my doctor's competency, just to cover his or his/her pharmacy's a$$. Ask the doctor and not the patient. I don't have a problem if they ask me if I am taking any other meds besides what I am picking up, for my personal safety, or if they ask if I'm familiar with the meds or how to take them to make sure I will be ok - just don't make me announce to all around me what is wrong with me.
And honestly, to all of you so called professionals that think you know so much: You certainly don't know how all the patients feel having to announce their health issues to all within an ear's reach. I would gladly trade places with any of you. And in my opinion, one of the things that has really gone by the wayside over my many years, is bedside manner, and that does for pharmacists as well as MD's, DO's, STUCKUPJERKs, or any other letters.
terrydiego213
15 Jan 2015
For those who feel that your pharmacist should mind his/her own business and just fill what the doctors prescribed, please feel free to do a little research on the DEA crackdown and check out the Board of Pharmacy of your state. Under their website, you will see many pharmacist licenses that have been taken away because of mindlessly filling controlled medications without verifying and checking the legality of the prescribed. Here is one of many examples that occurred in Southern California. http://abc7.com/archive/9003285/
Yes, primary care physicians (don't want to say doctor because there are many healthcare professions that has that title nowaday, MD, dentist, physical therapist, optometrist, pharmacist) do 4 years of medical school plus additional residency BUT the key difference is that they are taught to diagnose and the patho and physio of disease states.
Smartgal
19 Jan 2015
A doctor of medicine is an MD and there is no other doctorate degree that is called an MD. A PhD is a doctor of another type, even English. A physical therapist is a PT and his/her assistant is a PTA. A dentist is a DDS and not an MD. An MD has gone to school for 12 years in the US.
A pharmacist or a Rph (registered pharmacist) or doctor of pharmacy has all the information on drug interactions so it behooves one to make sure they have all the scripts they take at the same pharmacy. It isn't as important which specialty you see for any given condition or disease when you take your prescription to your pharmacist. It is NOT, however, necessary for the Rph to know the DX (diagnosis) IE: an antibiotic, an antiviral. They are not doctors of medicine and don't pretend to be. It amazes me what mush I have read on this subject. Controlled substances are controlled just like your antibiotic is in many ways. You can't share either one with another person.
The misuse of pain meds is not the problem of the chronic pain patient, it is society's. The pain management specialist means just what it is called; a pain management physician. The pharmacist doesn't contact the cardiologist for a DX code as to why he prescribed a high cholesterol medication either. Each has its place and if there is any question (we had one when our PA wrote a script for Ritalin out of town from our physician owner) which was bogus. That warranted a call to us for verification. Geographical distance made no sense to the pharmacist but she didn't just say... NO, I won't fill this OR fill it because it was in front of her. It was at her discrepancy to do what she felt was needed. She did well. The PA lost his license and he needed to. This was his third offence. Controlled pain meds is getting lost in the "using drugs" zone and it need not be there. All physicians are aware of their state requirements as well as Federal regulations and the majority of them follow without questioning it. These "get cash in a hurry" docs write them for anyone and nothing is going to stop them until someone complains. The pharmacist has enough to do without questioning a patient as to WHY they have the script when it is filled out correctly. There is no HIPPA regulation regarding a pharmacist, or a secretary in a Psychiatrist office. They know what is going on with you by what is written. If a PCP wrote pain meds for over a long period of time, I would be suspect of his/her intent as a drug pusher. A specialist is a horse of a different color. A pain specialist specializes in pain and that makes a huge difference in how a pharmacist may look at any script. I am out of breath just typing all this. Hope this clears up some questions out there.
PhaRxmD
28 Jan 2015
Smartgal:
No one has previously stated in a post that people who possess other doctorate degrees may be called an MD. However, they may be referred to and addressed as "doctor," whether in a professional or academic setting, hence why the previous poster was making the distinction of preferring to the MD as the "primary care physician" as opposed to simply "doctor."
Also, an MD does not go to school for 12 years in the US. They go to school for 8 years, followed by usually 4 years of residency. Some specialties require more years of residency. Any pharmacist who has graduated after 2003 has to have completed a PharmD. Most PharmDs also take 8 years of school (although some do accelerated 6 year programs or complete just 2-3 years of undergraduate before starting the 4 year doctor of pharmacy program).
There is also an optional 1-2 years of pharmacy residency after completing the Doctor of Pharmacy degree for pharmacists wishing to specialize in a specific practice, such as ambulatory care, psychiatry, oncology, nuclear, etc.
In regards to whether pharmacists need to know diagnosis information or not, in some instances, it actually is sometimes necessary for a pharmacist to know the diagnosis for a number of reasons.
The diagnosis code is necessary in some states for insurance or Medicare/Medicaid reimbursement purposes. In the state in which I practice, a prescription covered by the patient's Medicare Part B must have the diagnosis code included in order for the pharmacy to receive reimbursement. The laws vary by state, so this may not be the case in your state.
Also, plenty of drugs have different dose ranges for different diagnosis. This is particularly true for things like antibiotics, which can have severe side effects if dosed too high or can result in sub-optimal therapy levels if dosed too low. Certain types of infections may require a higher than usual dose in order to achieve adequate concentration at the site of infection, in which the benefit clearing the infection as soon as possible outweighs the potential dangerous side effects. Such doses may normally raise alarms unless the pharmacist is aware of the actual infection being treated so that they can verify the dose accordingly. Prescribers I have worked with have never given me any problems with this and some have even simply told me the antibiotic they would like, what the diagnosis is (whether site of infection, intended prophylaxis, etc.) and ask me to do the dosing.
Another example of why a pharmacist may need to know a diagnosis is for communicating with the insurance company to try to get an override for a medication that they normally do not cover. For instance, I've had a patient who was being given Viagra. A lot of insurance companies will only pay for a limited supply of erectile dysfunction drugs or do not pay for it at all if it's only being used for erectile dysfunction. In this instance, the insurance company was not paying for it's regular use. I had to find out from the patient that it was actually for pulmonary arterial hypertension, which I then communicated with the insurance company and they gave me information in order to request a prior authorization from the prescriber for an override of the insurance coverage.
In addition, some drugs are contraindicated together except in very specific medical circumstances. Take for example ACE-I (angiotensin-converting-enzyme inhibitors) and ARBs (angiotensin II receptor blockers). Their concomitant use is almost always contraindicated due to its lack of mortality benefit and increased risk of side effects in clinical trials. However, there are very specific heart failure patients (certain NYHA Class IV patients) for which the concomitant use may be warranted. A good pharmacist would know never to fill an ACE-I and an ARB together, but an even better pharmacist would know to ask about the actual medical diagnosis and if it's a patient with NYHA Class IV heart failure who has already being treated with all other options and is still symptomatic/uncontrolled with just ACE-I or ARB alone.
There are some medications that also have different uses and its condition contraindication is dependent on the diagnosis. Take for example the medication misoprostol, which may be used to induce abortion. This medication, however, is also used to prevent gastric ulcers. Whenever I dispense this medication to a female of child bearing age, I make sure to ask about possible pregnancy, and if the patient is pregnant whether it's for an abortion or for gastric ulcer prevention. Normally a pharmacist can tell based on the dose and if the patient also fills an NSAID, however sometimes prescribers use non-standard doses and the patient may be filling their NSAID at another pharmacy, so it's better to err on the side of caution in order to prevent any adverse events. What's an intended effect in one diagnosis may be a terrible adverse effect in another.
Long story short, you are correct, Smartgal, that pharmacists have the knowledge regarding the medications and their interactions, however without the diagnosis, it's sometimes difficult to determine appropriate dosing and special considerations for interactions and contraindications. The pharmacist is part of the healthcare team and a lot of the questions we ask are to try to comply with the federal/state law or to try to provide the best possible care we can.
kaismama
26 June 2015
Beautiful explanation, but I'm afraid those who want to be ignorant will continue to be ignorant.
mona87
19 Nov 2014
First: Your pharmacist (doctor of pharmacy) has an equivalent degree as your medical doctor (doctor of medicine). And therefore is a doctor and an integral part of your healthcare managment. In many states controlled substances have to have a diagnosis on the rx, along with some other information. The pharmacist also by law has to ensure that all rx's for scheduled drugs are legitimate, no matter what state you are in (federal law). If you think that your prescription is none of your pharmacists business you are being ignorant to the fact that they are, in fact the best doctor to tell you if a medication is appropriate, at a proper dose, and won't interact with any other medications you may be taking. A doctor of medicine has only had one semester to learn about drugs, your doctor of pharmacy, 4 years.
kaismama
19 Nov 2014
I don't know why people don't understand what a pharmacist is trained for. They don't just learn to read scripts and fill bottles. They know more about medications then any medical dr. And they must know what a drug is being used for so they know its the appropriate med. That's their job. And anyone who wants to keep their diagnosis a secret is a fool, that pharmacist is not going to remember, much less talk about it to strangers. You can't do your job with one hand tied behind your back.
cplumbley
9 Dec 2014
Wow!! The very suggestion that a pharmacist is equivalent to an actual medical doctor is beyond absurd. Earning a degree to be a pharmacist is an achievement that one should be proud of. Unfortunately a pharmacist does not have the same prominence as a medical doctor. Rather than enjoying your status as a pharmacist you have deluded yourself into believing you are an MD peer.
mona87
9 Dec 2014
Sorry you seem to have no idea what you are talking about. They are equivalent degrees, both are professional doctorate degrees and are both exceptional achievements. I in no way said that pharmacists are MDs, they are PharmDs. You evidently do not understand the proper roles and education of pharmacists and medical doctors. Attempting to demean them with your accusation that a PharmD is not an achievement to be proud of is baseless and classless. P.S in many states and the VA pharmacists are considered prescribers and can give and Rx to patients.
cplumbley
11 Dec 2014
I specifically said that “Earning a degree to be a pharmacist is an achievement that one should be proud of” Please read the post before commenting..
kaismama
6 Jan 2015
A pharmacist is one of the healthcare team and has more education about medications then any doc. He/ she has a right to alter things and tell a dr if he's wrong about a medication. The dr isn't the one person on the team with all the knowledge, if you think that, you are deluded. He depends on all the specialists to help him with his decisions. Having a degree in medicine is not the thing that makes you able to help a person. Pharmacists can even be doctors too. My friend has her doctorate in pharmacy and I would depend on her for help on medications before any md. I really think you people think pharmacists are some subservient tech. with a yr of education. Nothing is further from the truth.
pharmer3
11 Jan 2015
yep. pharmacists don't know anything until they save your life from a massive doctor screw up. how do i know. i have been a pharmacist for 17 years. I work in a hospital and every week I have to STOP at least one thing or more that would cause SERIOUS patient harm if i let it go thru.
Smartgal
19 Jan 2015
Mona, a Pharmacist is not necessarily a doctor. A Rph is a Registered Pharmacist and went to school for a long time to get that education. There is such a thing as a Pharmacy Doctor. However, they are trained ONLY in drug usage and contraindications of any other drugs you may be taking. A doctor of medicine goes to school for many years trained first in basics then in specialty. Afterward, they become Board Certified if they so desire in their chosen scope of practice. Now, the Pharmacist cannot possibly diagnosis what is wrong with anyone and it may vary by state, but I have 0 knowledge of any DX code on a script. Can you read a script? It is written in Latin. I worked in a Pharmacy for several years then went to the medical field. Not only can I read a written, typed or escript, but I know DX codes as I billed for payment. No script I ever saw had a DX on it as the pharmacist would be coming between the patient and the doctor relationship which is considered sacrosanct.
If the pharmacist needs help understanding the script, they certainly call the doctor, however I never heard my Pharmacist ask or had one of my doctors I worked for asked for a diagnosis for any script. It is the doctor/patient relationship first and the patient/pharmacist second. I would always make sure all prescriptions are filled at the same place because all the years dedicated to school warrants you knowing what might contraindicate a drug or supplement you now take. All physicians want to know what you are taking but they don't have the time or inclination to look up what might contraindicate another drug. We are lucky we have both specialties to help guide our healthcare.
bobo115
31 Dec 2015
Absolutely spoken like a pharmacist and almost completely false!
bwb1976
12 Aug 2016
hello
I was once told by a pharmacist that if your doctor prescribes medicine within normal amounts. and is dated and filled out correct, without a future date to fill on it. they can fill meds, if insured or not you can pay out of pocket and that's it.
now some local pharmacy have new and different unwritten policies, I would like to know if it is legal for the pharmacy's to make up policy when its not a law. funny thing different pharmacist at same pharmacy have their own policy.ex. was getting 30 day supply and they will not fill until 3 days prior so 27th or later day, then after the 3 day early policy I was told if supply qtyis less then 30days worth then they will only fill 1 day prior so 24th day?
this is only in our area once in bigger city have not heard anything like these policy's that vary. some pharmacist start counting day you get medicines other start 2nd day after? I tried asking about policies but feel like im a bad person for asking.i just want to know whats what shouldn't depend on whos working that day.
doctor writes script bring to pharm they then call doctor to ask if they can fill it isn't that why its dated the way it is not do not fill until then calling busy doctor would make sense. but when meds are same or close to for over 1o years wtf and pharmacy's make profit from scripts they are costing themselves millions and if its not a govt law why would they do this goafter the doctors who give narcotics to anyone as long as they have 200 cash
unouno64
8 Nov 2013
Legally speaking when a customer asks to buy something in a pharmacy, the customer enters into an agreement known as 'an invitation to treat' thus a pharmacist must insure that the drug is appropriate for use. This insure that the public is protected from misuse.
Secondly, ethically speaking it would be very unprofessional for a pharmacist to dispense a medication when he/she is unsure of the diagnosis or if there is any ambiguity around the prescription. As it is of course the pharmacists responsibility to interpret and insure a prescription is appropriate.
Thirdly, Health professionals can share information freely between themselves and this is not a breach of privacy provided it is done in relation to professional healthcare activities for the perceived benefit of the patient. A similar example would be that hospital doctors don't check with you every time to look at your chart, as they are legally entitled to do so.
As a surgeon myself, I am glad that pharmacists do check with doctors and I feel this question undermines and/or questions their professional status and their very important role in the community.
kaismama
16 July 2014
Hey bs, you are too rude to hang around here, go act like a jerk somewhere else.
Inactive
12 July 2013
These type of drugs are abused by people who hae found many ways to Beat the system". I can see this happening if the Pharmacist thinks it may be a fake rx or a stolen one. If you have nothing to hide, dial the number for the Pharmacist, get someone on the phone that can verify your rx. Once everyone has the info they need, you will not have to deal with this again. The ones that abuse drugs, and go to great lengths to get them make it harder for those of us in real need. Drs and Pharmacists have to cover their butts. Yes, that sometimes is inconvenient for us, but, once we have a relationship with both, its lots easier.
once again
11 July 2013
It is the new federal controlled substance law the dr is now supposed to write your diagnoses code on the script for controlled substances
RJ13
11 July 2013
I cant believe the number of responses here, that think a pharmacist is something of a "clerk" where you hand them a piece of paper, and they have a legal obligation to hand you exactly whats written back. I am a pharmacist, I happen to work in a hospital clinic, but in any setting, a pharmacist is a HEALTHCARE PROVIDER, a professional with a license. It is absolutely within our scope of practice to request a diagnosis for ANY prescription ordered. A pharmacist also has every right to refuse any prescription they wish, if deemed so by their rationale, and that is a personal judgement call based on the individual patient and situation. The prescription should be handed back to the patient, EXCEPT in the case where a stolen prescription pad or clear fraudulent criminal behavior is suspected (yes we are trained for this).
I have held a presription for verification, confirmed with the physician that this individual stole a prescription pad from the office and then have proceeded to call the DEA/narcotics police to have that individual arrested. Yes, 9 out of 10 times we dont need a diagnosis or any verification on standard everyday meds, as its pretty obvious what the medication is for, but we have every right to ask a physician EXACTLY what the background story is behind the rational for that medication, because our job is to be gatekeepers, mainly for patient and public safety. Our job is actually to protect you from receiving the incorrect drug, dose, strength, maximum daily dose, etc. You would be surprised how many physicians write incorrect prescriptions EVERY single day, and how many pharmacists catch and correct these orders. (I correct atleast 10 physician orders here for chemotherapy on a daily basis, ofcourse I have full access to the patients entire chart, medical record, history, labs, etc. I make these changes here without even calling a physician, but this is a different practice setting.) And to put something else into perspective for you, different medications have different doses for different conditions, and without knowing the diagnosis, we have no way of knowing if the correct dose was written for that particular diagnosis. YES, that is within our scope of practice to ensure you get the correct dose to treat your condition while maintaining your safety on that drug, it is not solely the responsibility of your phyisician. If you develop an adverse reaction to that drug, even if your physician wrote the prescription, they can sue the pharmacist stating "well you should know that that is an incorrect dose for that medication" and Vicodin ES written very commonly as "1-2 tablets every 4-6 hours" could result in a MASSIVE overdose over the course of time if "do not exceed 5 tablets per day" isn't on the labeling, people have died from taking drugs as such, even under normal prescribed safe doses with the right intention over extended periods of times. And you can blame all the people out there who incorrectly use these narcotic drugs for this tediousness behind having a pain medication filled. Some pharmacists personally dont give a sh*t anymore and they'll just fill anything, you may think they're being nice and respectful and curteous, but in reality, they are lazy, dont want to make the extra phone call and just dont care about the narcotic epidemic in this country and rather take the easy way out and fill anything and everything. That is not an ideal pharmacist from a practicing perspective.
kaismama
11 July 2013
I am so glad to see you stand up and yell. I find that at least daily I'm telling people ask you pharmacist they are the experts on this. I don't believe in other countries they have the education you guys do. I've picked up often that people think pharmacists are little more then someone trained to fill pill bottles. If I want to know about a med, I ask a pharmacist not a dr. The people in this country don't read lables or monographs either.
fayfaith
15 June 2014
RJ13, I want U as my doctor!!! U certainly have the intelligence n than some. :)
Pedro34
25 Jan 2015
Hey, Glad to hear you explain your wonderful credentials. Now I don't have to visit my heart doctor or any other of my doctors any longer. All I have to do is find a wonderful pharmacist with your background and have him/her treat me in the future.
wkcotton
25 June 2015
"being nice and respectful and curteous, but in reality, they are lazy, dont want to make the extra phone call and just dont care about the narcotic epidemic... "
Oddly, I'm a pharmacists and I'm respectful and courteous but I don't mind using a phone AND I've never thought of myself as lazy.
Now I can't speak to your specific work environment but if someone changed a chemo prescription, that wasn't egregiously wrong and OVERTLY a typo, without discussing it with doctor, I would fire and/or report them in a heartbeat.
Personally, it sounds like you are to bitter and jaded to deal with the public, but best of luck to you.
Mel78
2 June 2013
No.. They are and would be breaking HIPPA if they requested that information from you and many states it isn't required to have DX on script either. Good Luck and report if asked again.
kaismama
2 June 2013
You are wrong, HIPPA allows for need to know, and with this they need to know and its within their rights. They are part of the medical team treating, not a stranger. Also the law requires certain info for narcotic prescriptions and they have to ask. If you start yelling HIPPA regs, about this, they can just refuse to fill your prescription.
Artsyastro
31 Jan 2016
I am adding this comment three years later and feel a bit silly doing so, but am continuing because, despite the age of the thread, it was close to the top of what I searched on google!
As someone else stated, many people have access to and review an individual's medical info and are within HIPPA compliance. Your doctor who creates the record, members of their office who organize it, then it's sent to insurance, where, depending on situation, your record gets passed through several departments.
From my own experience, when a pharmacist asks for dx info, it isn't them being nosy, many (if not all) insurance companies insist that a code be on (at least) the first script of any given med from any given Dr. I know it's a hassle when a doc forgets the info and you need to then get a new revised script, but take a step back and think. Obviously, your insurance company wants a record of your health that is as comprehensive and accurate as possible. the pharmacist submitting a request for coverage for a med may be the first time an insurance company is aware of an issue under a catagory covered by that med. if say you get a script from your GP who addressed multiple issues in one appt, the two or three codes they add to your file may not cover everything you did in the appt.
Pharmacists have to be detectives. They may be the only one to notice that the med you get from one doc for one issue will react poorly with something from another doc. The post that started this thread mentioned pain killers... You may not be abusing them, but if you let it slip your mind that your neurologist gives you a muscle relaxer when getting meds for acute pain... That pharmacist understanding your history may be the only thing standing in between you, and DEATH.
Sorry for rambling here, it just genuinely worries me that so many people seem to lack a basic ability to apply common sense, let alone take a sec to see beyond initial inconvenience!!
jajhr
14 May 2013
I just had a pharmacist fired for not only refusing to fill a script, but throwing away the script and calling the er doctor and arguing with him. This guy didn't know I had three broken bones, bruised ribs and internal bleeding. I hadn't used this pharmacy in years either. They are NOT MD,s. If they won't fill a script they must give it back to you and allow you to go elsewhere and make a big public display before walking out. After filing a complaint with his boss and the board of pharmacy, he was fired.
kaismama
14 May 2013
The pharmacist is within their rights to refuse to fill a prescription. They aren't doctors but they are professionals with licenses to guard. What they can't do is pitch that script, or make a scene with you. And the pharmacist should have had the reason for the script on it, by law. One thing about professionals in healthcare, the law does not force us to do something that we think is wrong or against our ethics.
jajhr
14 May 2013
I did my homework before filing my complaint. The laws very by state and like the dumb birth control moral controversy, they must give you the script and allow you to go on your way. Of course I was told this guy had had several complaints already against him. Walgreens as it turns out has very tough staff meetings but they are told what they can and cannot do. Turning themselves into your doctor is one of them and not giving you your hard copy written script back is at the very least cause for getting written up and then like in this case, fired. I'm not stupid. I know when something wrong has occurred or I'd never bother taking the time to do what I did. My only regrets? He had access to my home address before his dismissal. I will also take a moment to sing the praises of Target. Their staff are respectful, kind and go out of their way to accommodate and help you within the law of course. When I am within my rights, I exercise them to the fullest extent of the law.
jajhr
14 May 2013
Vary*
RPhinDaytona
3 June 2013
First off, I will destroy any narcotic prescription that can not be verified by the prescribing doctor. If I feel a prescription is forged & I give it back to a patient, then I an accomplice in their illegal endeavors. An ER prescription can be a difficult one to verify since ER doctors write scripts & forget the patient. Getting a call through to them can be daunting. I have never made a scene with a patient, but have had patients make asses of themselves. I tell every patient that is presenting me a narcotic prescription that I will verify it prior to dispensing and once it is in my possession it will not be returned until I speak to the prescribing doctor or an agent of said doctor. I laugh at your overblown story that you were able to have the pharmacist fired or had anything to do with their termination. The Board of Pharmacy encourages us pharmacists to prevent fraudulent prescriptions from being filled or returned back to the presenter if it may be fake.
If anything the BOP errors on the side of caution when dealing with these matters. What you left out of the story is that the pharmacist viewed on E-Force that you are a doctor shopper who presents narcotic scripts from multiple sources to multiple pharmacies for filling. You probably had some half assed excuse why you needed more meds when you just filled something days earlier and should have still had some on hand. But kudo's for your silly story and you chest thumping as a leader of the pill head community.
jajhr
21 June 2013
Since you're commenting on MY post, I'll let other viewers know Tramadol is not a federally controlled drug and California does not have any state laws passed on it, so the idiotic (and frankly embarrassing) actions of the pharmacist involved was as mentioned before... fired. If pharmacists wish to verify certain scripts on their own time, have at it. If they do and the Dr. verifies the script, FILL IT AND DO YOUR JOB. While certain patients could possibly throw a hissy fit while visiting their local pharmacist, it has absolutely nothing to do with my situation, so including that in your post was irrelevant.
With that being said, whenever the law is broken along with normal protocol, I can assure you I will and would always throw the proverbial hissy fit for justice. Since the A-hole was fired, that makes ME RIGHT.
RPhinDaytona
13 July 2013
A couple things:
1)if you are trying to fabricate a compelling story, research the topic just a tad. Thinking anyone with a day of pharmacology education would believe an ER doctor sent you home with just a Tramadol Rx with 3 broken bones, and bruised ribs would only be more absurd if you said they then prescribed powdered unicorn horn for topical administration as an anti inflammatory. And if anyone is getting fired it would be an ER doctor discharging patients with internal bleeding.
2) You then said: " If pharmacists wish to verify certain scripts on their own time, have at it. If they do and the Dr. verifies the script, FILL IT AND DO YOUR JOB"
Do I come down to Taco Bell and tell you how to scrub the toilets while you are on the job? No, then don't proceed to think you could fathom the duties I perform in the daily activities of my PROFESSION!
I would love for you and all your knowledge to come to my pharmacy and try to pass your fake script. After you tried to educate everyone with all of your knowledge, you would be escorted out of the pharmacy with your paper script(if I felt compelled to return it to you in one piece) with a detailed explanation written across the face telling why the prescription was denied being filled at our pharmacy, a list of doctors, nurses, and fellow "relevant" medical professionals as well as the exact time I spoke with them would also be documented as well. And finally I would place a remark in your harmacy account indicating that you are a doctor shopper and that you try to intimidate people by making a scene as a technique to get your narcotics. This way any pharmacist working at another of our chain stores would have a heads up when you come in!
BOH1066
18 Feb 2014
the law does prevent the from DESTROYING the script.
Whitey Joe Young
2 Aug 2014
JAJHR is incorrect about Tramadol. It is Schedule IV on the schedule of controlled substances. The lowest level of concern is Schedule V. Tramadol does require an Rx for dispensing, so it IS federally regulated and by implication, regulated as a "Dangerous Drug or Device" under the California Business And Professions code regulating pharmacists and pharmacies.
I just can't believe all the bulls**t answers being handed out on this thread. Ridiculous. Oh, by the way, EVERY drug is Federally regulated by the FDA. Period. Many, however, do not require Rx's for dispensing. They are called over-the-counter drugs.
PoisonAlice
25 April 2013
It's within your pharmacist's rights to do this. They also have the right to refuse to fill a prescription if they feel you might have a problem with the medication, even if you're not filling it early. It's hard enough just getting the pain meds prescribed, but then you constantly have to worry if the next time you fill it the pharmacist will decide not to fill it because they think you might be exhibiting "addictive behaviors" (which are so vague, they're BS).
kaismama
26 April 2013
Did you know that one of the ways they judge addictive behavior is how you're dressed.
PoisonAlice
26 April 2013
That's absolutely disgusting. I'm sure I get judged because my teeth are rotting from the inside out, which has been happening years before I started taking pain killers (I blame being on antibiotics for the majority of my life). I know I also get judged because I have panic and anxiety disorders and have panic attacks if something goes wrong with a prescription, which only seems to happen with my controlled substance prescriptions.
PurpleButterfies
26 April 2013
PoisonAlice, you poor thing, I know how stressful it can be when you have anxiety & panic disorder and problems arise, getting your pain meds included, that is anxiety inducing. You are not alone tho. :)
PoisonAlice
26 April 2013
Thanks. I tend to get the panic attacks if there's an issue with the prescription or my insurance and I run out on the day or the next day and I'm getting it filled on a Friday and wouldn't be able to get whatever the problem is fixed until the following Monday. I get all panicky about the prospect of going through more pain than usual without my pain meds, which is terrible. Luckily, I've been going to my pharmacy for years, they know me well enough to kind of "forward" me enough to get through until the following Monday when I can get things fixed, because they know I'm good for it. But they're a "mom and pop" pharmacy run by the local hospital, I don't know what I would do if I were ever to have to start going to another pharmacy, as I've noticed that the pharmacists at the local chains are SO judgmental!
PurpleButterfies
26 April 2013
I know exactly the kind of situation you are talking about with getting your pain meds. You are VERY fortunate to have a pharmacy that works with you as you said that is not usually the case. Try not to think about what if you were to have to go to another pharmacy, try to focus on the fact that things are working out ok for you right now. Take care!
PoisonAlice
26 April 2013
Oh, I'm definitely thankful for the pharmacy I have now, but every once in a while, particularly when I have an issue with a prescription,I think of what if I had the same problem at another pharmacy. Also, I get a few special order prescriptions, and they literally come in overnight, on weekdays, and all the other local pharmacies take anywhere from 5 days to 10 days, sometimes even longer, to get in special orders!
jajhr
15 May 2013
Laughing at the comment about being judged for the way you're dressed. Recently at a market in the am, a lady was behind me in line in pajama pants and her ratty old bathrobe. I glanced at her along with her four kids all under the age of 8 and she smiled and said... " We ran out of milk. A crime in our house. I had to act fast.". So judging by how you look is a typical prejudiced thing to do and very wrong. Am I surprised? Heck no. I've come to expect the worst in people these days. Sad, but true.
jajhr
15 May 2013
@poisonalice... Can a family member or friend help you with phone calls? I only see my PA twice per year and get 6 refills. By law , after four of them the office needs to ok the last two remaining refills which like a lot of similar stories, starts a chain of phone calls. Did they fax it yet? Did it get faxed back? Did I make my follow up calls before the dumb drs office closed for the day? Lol. I once counted 18 calls because the chain of communication broke down. My PA said he can change my scripts to get two or three myths at a time like I used to do, but I haven't pushed that. A few calls doesn't bug me. I can live without the meds for a few days if something happened so if this is a hard problem for you, I thought maybe someone else could help you out... just a thought... I'm a spinal fusion patient with several back surgeries and bone grafts in my past. I try to keep my weight down and get on the treadmill as often as possible.
The more you stay healthy in other areas, the better you do. I've had to fight through all the pain. It will be with me for life so I try not to let the whole thing define me. It can be really tough though...
blueeyesdancing
31 Dec 2014
I understand a pharmacy can ask these questions. But, what if a mom & pop pharmacy asks other people about your diagnoses before calling the doctor? Wouldn't that be a hippa violation?
Pedro34
25 Jan 2015
My pharmacist just stared this practice of requiring customers to describe our surgeries and illnesses in order to have our prescriptions filled. I checked with a reliable legal source and also a hospital manager and was assured this is in violation of HIPAA, of the Privacy Act. So, I have today filed a charge against my Pharmacist for violation of my rights. At my pharmacy we are questioned at the window where we hand in our prescriptions. It is in public and usually has several other pharmacy customers waiting in line who hear all the personal details. My uncle recently had hydroceles surgially removed from his testicles and scrotum. (An inherited condition) Can you imagine standing near strangers and having to tell your pharmacist about this highly personal surgery just to get a prescription filled for your pain. Pharmacists have no rights to do this and it is none of their business.
As for our law enforcement, they should be far more concerned about recreational drug abusers and leave the pain medicines alone as prescribed by doctors for patients suffering from ailments, surgeries. etc. The world is upside down. I fully expect the Federal Civil Rights Department to promptly investigate and fine my pharmacist for this pernicious practice. I am informed the penalties for violation of HIPAA are quite steep.
Davevgray
30 Aug 2016
Pharmacist sometimes abuse the power they have, I have been in pain management over 20 years, I 've been disabled for the past 5 years. Supposedly it is against the law for them to deny a legal script from someone who is disabled, but this happened to me. I put in a complaint to the department of Justice but I doubt anything will be resolved. I have been dealing with this pharmacy for the past 5 years. Usually people have to deal with this after a pharmacy has been audited by the DEA.
PatientBeInformed11
6 Jan 2019
Good for those who stand up for their rights! Profiling patients is common. I knew it was happening years before I finally had a word for it. I am completely innocent of any medical lying, etc., but I always worried about what I was wearing to see the doctor. Finally, I stopped worrying about ti when women wear just about anything they wants these days. It's a really creepy feeling.
DzooBaby
23 April 2013
My Dr has to put diagnosis codes on my scripts. The pharmacist has every right to this information. You would be surprised how many people view your medical information. They all must adhere to HIPPA laws but it still lets allows quite a few people view your medical information, to pay claims for instance.
kathyhanson
22 April 2013
For you pharmacy to receive payment from your insurance provider, the claim they submit must include an AMA diagnosis code, as well as an AMA procedure code. Many of my scripts just say something like "Take every 4-6 hours for pain". That is all the pharmacy needs. But to answer your question, yes, the pharmacist can and must know your diagnosis for insurance purposes, even if that diagnosis is "pain".
Zappajvp
21 April 2013
It was just weird this is the only pharmacy I have used for 3 years and never had any issues whatsoever. My doctor was pissed and told her once you go to medical school you can ask my patients that. It wasn't an early fill or anything. It was at Walgreens wondering if they got in trouble? So in other states the reason for the Ned's just be written on script? So invasive.
mhelcl
21 April 2013
The key for you is to not take it personal. Anyone who dealt with chronic pain for substantial period of time can tell you stories about similar things that just happen in this territory..
kaismama
21 April 2013
Walgreens has had major problems with the dea. Your dr is way out of line she is just doing what the law requires. If he wants to prescribe narcs he's going to have to play the game or hell have his a+= in jail and not have a license. A pharmacist has more education about meds then your dr ever had.
kaismama
21 April 2013
In case you haven't figured out, this is not a free country for chronic pain patients nor do we have any privacy.
Zappajvp
21 April 2013
That makes me feel better to hear that being treated like a criminal for nothing wasn't fun.
kaismama
22 April 2013
All of us get that treatment, i was told in front of other customers that i was a drug abuser because i wanted to refill my 30 day prescription in 30 days!!! That was at a Walmart pharmacy. I won't ever use them again. Don't take it personally were the victims in the war on drugs. Walgreens is also requiring a photo id to get a narcotic prescription.
sara12345
22 April 2013
Kaismama, Thanks so much for sharing the name of the pharmacy, Walmart, who treated you so abominably. Sara
billnterrac
23 April 2013
I JUST ran into issues with Walgreens. They are not able to fill my morphine or my norco due to DEA issues and they don't know when they will be able to again. I had to find a pharmacy that would fill it quickly as I was running out, then get in touch with my pain clinic to let them know I will be using different pharmacies for this fill and for my next one. I used a local supermarket this month and will try CVS for my next refill. Apparently the clinic already knew this... could they have let their patients know? I bet they could have instead of having us scramble looking like druggies trying to find a place to get our next fix... I wish you all luck in health and medical concerns. TC
AiursLIght
16 Nov 2013
"My doctor was pissed and told her once you go to medical school you can ask my patients that."
I wouldn't have taken that well... I've only had to challenge a physician once so far (they wanted me to give a live-virus vaccine to a patient with a compromised immune system), and they were respectful about it. Faxed over the patient's tests and I gave my go-ahead.
See, when a pharmacist fills a prescription, it's under their license. If anything is wrong, then it's their license on the line. The insurance company will come after us, the board of pharmacy will take some kind of action depending on the severity, and you the patient would likely be advised to sue the pharmacy or pharmacist that made the mistake.
I've never had a physician say something like that to me, but if they do, I'd probably not want to take their scripts anymore. If they're so cavalier with how they treat a pharmacist, they may just be the kind of guy who'd throw me under the bus when they write a bad script and I don't stop it.
As for your last bit, yeah, quite a few states require a diagnosis code included, especially if it's billed through medicaid. It's not invasive: we're there to be the last check for medication safety. Suppose your physician wrote a prescription that was contraindicated for your diagnosis by mistake, or (more likely) got the dose wrong. Even when I was an intern at my pharmacy, I've had to call physicians' offices for dose corrections. Now that I'm practicing, I get a half-dozen or so every day at my little store. Most of the time, patients never find out that we had to do this: your correct dosage is printed on the label, and we have the courtesy to not draw attention to how your doctor botched your script.
noneofyourbuisness
12 Nov 2014
Im on you and your doctor's side! And whoever said your doctor was out of line and going to get in trouble and that the pharmacist nows more about the rx than the doctor does really should not even comment about anything! Doctors went to school for a long time and had to learn about way more than a friggin pharmacist! The doctor is qualified to prescribe medication that is what is going to take care of the diagnosis and has the degrees in order to prescribe the medication he feels is best suited for the patient! The doctor has the patients medical history and prescribes medication accordingly.
The pharmacist lately think they are god and that they have the right to go against the doctors prescription written for the patient and they have no right to fill certain people's rx and then will not fill others rx! They are discriminatory and they are not there to designate who gets their rx filled and who doesn't get it filled! They are there to fill the prescription the doctor prescribes for a patient and make sure the patient is not taking something that is going to have bad interactions with other medicine that they are taking or was also prescribed. They need to do their job and fill prescriptions prescribed by the doctor for the patient and be sure there's no rx interaction. Not decided not to fill an rx because of the way a person looks or not agree with the rx because its a narcotic!! Your not god do your job and stop being judgmental and worry about yourself not other people's lives!!
Gardening Gal
2 July 2015
I just returned from Walgreens where I have been getting pain meds filled for the past 3 years. A new pharmacist told me she had to call the doctor for a diagnosis in order to fill the meds. I had back surgery 6 months ago and still in pain. Then she told me they don't work over time and I should try alternatives. Injections, non-steroidal. WOW! I was very upset as now I don't even know if the script will be filled. I may try a new pharmacy.
Statman
27 May 2016
Pharmacists know WAY WAY more about drugs than doctors. Doctors become experts in their specific field, and know drugs generally required ofr their specific types of patients. In total, physicians take TWO courses in pharmacology, and then spend the rest of their time learning about their narrow field. Pharmacists, OTOH take about three dozen courses on pharmacology, pharmacokinetics, bioavailability, etc. In an ideal medical system, doctors would diagnose, and pharmacists would choose the drugs you'd take.
A pharmacist is 100% within their right to ask about a diagnosis, call a doctor to verify any prescription or its details, keep a prescription they think is fake or forged, etc. they're also 100% within their rights to call the cops and have someone arrested if they think a script isn't legitimate. My wife is a pharmacist and has, at times, worked closely with police to catch forgers. She doesn't generally call the cops on a suspect script - she just declines to fill it. But if the cops ask her to assist, she always will.
lisatroop120
9 Nov 2018
I have been with my pain dr for so long that I never signed a pain contract. I have never had anyone else write me a pain med. Monday I was leaving town & saw my PCP for my anxiety meds I’ve taken for almost 2 years & my pain dr knows, #1 because I told him when I first started & #2 because I am drug tested every 90 days! I have been using Walmart by my house, but stopped at the 1 closest to Dr. I ask after I filled if I could get my refills at my normal store & they said yes. Browsing the store & when I came back the pharmacist said I’d been red flagged for the meds I was on & they called my pain dr office & was told they weren’t aware I was taking.
Until the pain dr called my pcp to see what the diagnosis was & treatment plan going forward they would not fill, I was embarrassed and livid at the same time! I ask if I run over to my dr could they just forward so I could pick up by my house or in the state I was going & was told NO if sent to another store they would do the same thing he was doing. After getting to my dr office & telling them what happened they agreed they did know & the dr was overwhelmed with patients who were on much stronger meds & several pharmacies were calling wanting diagnosis & then still denying because the meds now needed preauthorization! They said go to pcp since they prescribed & have them call pharmacy. I called Walmart back and spoke to the other pharmacist to see exactly what was needed. I ask if this was something that went into effect 11/01/18 was told it went into effect in May 2018 & these 2 pharmacist mission to put a halt to unnecessary medication! I am so glad I got the written script back!! I took a chance and dropped it off at the Walmart I always use told him I’d be in store waiting & within 5-10 minutes I received a text my script was ready! I’m on Medicare advantage 1 med is tier 1, the other is a tier 2, and the 3rd is not covered by Medicare unless I try something else 1st and if it doesn’t work require authorization so I just pay cash because it’s only $8. I wasn’t even getting all 3 scripts!
martini78
8 Feb 2020
Walgreen's in California has just asked me for a code. I am changing new pain dr. and he gave me a script for only half of what I've been receiving for 6 years from 2 different pain mgmt doctors. Changed after surgery in 2017. So pharmacist knows all this has access to surgeries etc. like drs. But refused to fill until they get a code. The office never called back Thursday by 2 I asked them too. Anyway I called my dr at 4:15 but just received answering machines. All were busy. Called pharmacy at 10am they were waiting I reiterated to them they were gonna call back since they wanted it. It's not the law but it's theur right. Well no Dr or PA in the office so now I have to wait till Monday. Since the dr sent via EmAil program I cant just pick up and go to another pharmacy. Well sitting in ER just to get a shot for pain and I will come back tomorrow until prescription is filled.
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vicodin, vicodin es, pain, pharmacy, doctor, medication, pain management, pharmacist
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