Health & Medicine

Why California pharmacies are rejecting some prescriptions for pain medications

Doctors around California are complaining that the state did not send them notice of a Jan. 1 change in prescription forms and that pharmacies are rejecting prescriptions for controlled substances on forms they used just last year.

Dr. Richard Buss, a family practice physician in Jackson, said this is the second year the state made changes to prescription requirements without notifying doctors directly. He said he was unaware of the change until Jan. 2 when a pharmacy told him it wouldn’t fill a prescription. He was unable to get new prescription forms that meet state requirements until Monday.

“Nobody told the doctors about it — until like now — when the change is required,” Buss said. “Pharmacies are already refusing to accept our prescriptions for controlled substances. One of the doctors at our hospital is trying to send a patient home who just had knee surgery, and he can’t get pain medication ordered for her because these (prescription forms) became out of date at the end of the year.”

The California Medical Association has been hearing from physicians up and down the state about this issue, said Anthony York, a spokesperson for the organization, and CMA is working with the Medical Board of California, the California State Board of Pharmacy and the California Department of Justice to ensure that providers can serve their patients effectively.

Assembly Bill 1753, sponsored by Assemblyman Evan Low, D-Silicon Valley, went into effect on Jan. 1. It limits the number of printers authorized to produce prescription pads for controlled substances and requires the forms have tamper-proof measures to make them easier to track and harder to use if stolen. The measures were intended, Low said, to help stem the opioid crisis.

On Monday, Low issued a statement acknowledging there have been some problems with how the law is being implemented. In the statement, he said he has communicated his “grave concerns” in a letter to the Department of Justice, and is “committed to seeing that any legislative solution is signed into law immediately.”

The Medical Board of California issued a memo Dec. 28 to physician prescribers, alerting them to the change. But that was too late, according to the board, which said on its web site that it still received a number of inquiries from providers complaining that their prescriptions were being rejected.

The Medical Board memo quotes the enforcement committee at the California Board of Pharmacy saying it will “not make any action or investigation a priority” against a pharmacist who believes it’s in the best interest of public health to fill a prescription with the old form and does so. Pharmacists also could ask for an electronic prescription or seek an oral prescription if laws allow that for the specified drug.

Buss, who has been practicing since 1987, said that old prescription forms will work for blood pressure medications or penicillin, but they are being declined for controlled substances such as pain medications containing opioids.

“This is an example of total bureaucratic and legislative bumbling, to not be able to make arrangements for a transition,” Buss said.

Lisa Folberg, the chief executive officer of the California Academy of Family Physicians, said her organization has not yet fielded calls from providers on this issue. The CAFP included an article on the subject in its Jan. 8 publication for members.

Editor’s note March 14, 2019: Since the initial publication of this story, The Bee has learned that the California Medical Board put Dr. Richard Buss on probation in 2015 as a result of an investigation into the 2007 death of a patient from polypharmacy, or taking multiple medications at the same time, according to board documents. The causes cited for the five-year probation were gross negligence, negligent acts and incompetence.

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