Thursday, August 7, 2014

Medication Agreements

I've talked about Pain Management Clinics before. You can read one of my blog posts here: LINK

A few days ago one of our regular patients brought in some scripts from a pain management clinic. These scripts come on a full page of paper. The top half is the Rx, the bottom half is a "patient agrees to the following" with a list.

One of the items on the list is that the patient agrees not to get narcotics from any other prescriber. In essence, the patient agrees to only see the pain management clinic for scripts for narcotics. That's a great idea, but I wonder if anyone in the clinic discussed this with my patient.


In addition to the prescriptions from the PMC, this lady also handed me a Norco script from another doctor, written on the same day. She saw two doctors that day. The scripts from the PMC didn't have a narcotic. They were just your usual Neurontin and Flexeril regimen. But, I wondered, where is the narcotic script? I imagine she's holding that one and will try to fill it later.

So I faxed copies of everything over to both doctors to see what they'll do in the future. As for this batch of scripts, I filled them. I didn't make the agreement and I'm not the PMC's sheriff. I gave up trying to be the judge and jury over these matters. I'll let the doctors sort it out with each other.

I really have to wonder if these "agreements" are enforced. I've encountered this situation with other patients before, who come in month after month with PMC scripts and ones from other doctors. Are the PMCs checking the DEA website to see what the patient is getting every month, or as I suspect, are they relying on the pharmacies to enforce their agreements with the patients?

And if that's true, why is it my job?


Pharmacist Steve said...

In my experience, these contracts are signed and put away...until they find some reason that they want to discharge the pt.. for some perceived wrong doing... then the contract is pulled out. IMO.. you did the correct thing.. notify the prescribers and let them make the final determination.. and hash it out with the pt. If the pt comes back next month with the same two Rxs ..two different prescriber..then I would have a talk with the pt and makes sure he/she understands the contract that he/she signed or agreed to by having the PM Rx filled..and inform him/her that after this month.. you cannot continue to fill Rxs from both prescribers. Prescribers are known for telling pts one thing and not sharing with RPH's. of course, document the consult in writing on the Rx

apieceofwork said...

In the hem/onc practice I used to work in, some state legislation forced us to tighten up our narcotic procedures, and we started requiring those contracts. Most patients were fine with it, some were just confused, and the dishonest few simply didn't care what they signed. One of our senior nurses ran a check on any patient requesting a narcotic refill, using the state's schedule Rx registry (KASPER). There, we would see whether the patient had filled narcotics written by other prescribers. If it happened, the patient was confronted and the Rx would not be written. It didn't come up often, but being close to the state border I imagine the crafty ones could all too easily circumvent this system.

Even though it was in our PMC, we didn't care much about which pharmacy the pt filled at.. presumably, as long as the pt filled in-state, all prescribers and pharmacies involved could easily look up the pt's filling habits.

So we enforced our PMC, on the rare occasion we needed to. I like to think that most of our patients, even the obvious or self-admitted addicts, really need their pain meds. However, I think if your children are "stealing" your drugs you need to get a social worker who can find better care for you than the rotten fruit of your loins. I would be glad to help you with that, ma'am.. but please do not ask me to call Medicaid to repeal your doubly denied prior-auth on a Friday while your doctor is unreachable. Sometimes I bend the rules, but your crocodile tears do not make them more pliable. It is help you need, not service.

Anonymous said...

Think this is a total CYA move by the doctors office so when the patient od's or liver fails they cannot be held responsible because they had an agreement. We will do our due diligence to a point but you are correct it is not our job to be sheriff.

me. said...

we in PA don't have a DEA website to look at :(

Anonymous said...

Aaaannnd people who do this make legitimate pain patients so angry. Granted, I refuse to see a pain specialist because I'm stubborn as hell. And because I don't want to take anything stronger than Tramadol. But it sure is infuriating.