Pharmacy companies may face penalties for failing to meet ‘partial-fill’ rule

By , Daily Memphian Updated: January 14, 2019 3:27 PM CT | Published: January 12, 2019 11:51 AM CT

Facing pushback on Tennessee’s new law to stem an opioid crisis, the state Legislature could consider penalizing drug and pharmacy companies for failing to comply with a “partial-fill” rule on painkillers, according to one architect of the state law.

When it passed the $30 million TN Together initiative in 2018, the General Assembly agreed to give companies a six-month reprieve to meet the requirement limiting painkiller prescriptions for new patients to three days and in some cases 10 days, according to House Majority Chairman Cameron Sexton.

“Come to find out, in the last few weeks we’ve heard from the Tennessee Pharmacists Association that the big pharmacies are refusing to do partial fills on the legislation,” Sexton said.

The Crossville Republican came up with compromise legislation to help the measure pass last spring amid a national crisis that saw 1,776 people in Tennessee die in 2017 from opioid abuse. Most of the funding goes toward coping with opioid addiction.

Sexton said he understands some companies say their policies are more restrictive than the state’s, while others contend their pharmacy software isn’t capable of meeting the requirement that took effect Jan. 1, so they won’t be following it.

The lawmaker mentioned Walmart as one of the bigger pharmacy companies refusing to comply with the law, as well as Walgreens and McKesson.

The “partial-fill” part of the legislation is designed to keep people from loading medicine cabinets with painkillers they’ll never use after medical procedures. Officials say those bottles of opioids often are stolen and wind up in the hands of children or in illicit sales.


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The Legislature will take up the matter in 2019, Sexton said, either negotiating with pharmaceutical suppliers and pharmacy companies and potentially adding penalties for failure to comply with the law.

“That was the signature piece of the governor’s TN Together plan and a big part of what we’re trying to achieve, which is to have less medicine on the streets,” Sexton said. “I think in the end, it needs to be a pretty big fee or fine or something of that nature. But also say, OK, last chance, how long is this going to take you to get your software up and going? There’s no reason a billion-dollar company can’t get their software (set up). I think at this point it just looks like they’re unwilling to do it.”

State Rep. Larry Miller, a Memphis Democrat who will start serving on the House Health Committee this session, said, “I’m certainly going to follow the lead of the chairman at this point if that’s something he needs to work on.”

The Daily Memphian is working to obtain responses from representatives for Walmart, Walgreens and McKesson. But at least McKesson, which was profiled in an unflattering “60 Minutes” story for allegedly flooding communities with painkillers, issued a white paper in 2017 calling for several steps, including permitting partial refills to “reduce risks associated with an excess of unused pills.” It also points toward the needs for a secure supply chain and better education for customers, physicians and pharmacists.

Part of the problem could be that pharmacy systems are required to follow the same standards for federal health laws set forth by the National Council for Prescription Drug Program, which restricts partially-filled prescriptions.

The council is seeking federal guidance on the matter, but pharmacists are hamstrung by laws requiring them to get a new prescription for the remainder of a prescription if the patient needs more medication.

Federal law supports partial fills if related to an inventory shortage, according to the national council, which is requesting a change from the Centers for Medicare and Medicaid Services. The national council with TennCare officials about the regulation, and Tennessee has issued guidelines governing the codes for initial fills, incremental fills and completion fills.

Nevertheless, Micah Cost, executive director of the Tennessee Pharmacists Association, said the number of opioid prescriptions for three days or less is increasing already.

“I think we’re seeing a lot of positive shift just in terms of lowering those thresholds for acute care scripts,” Cost said.

Yet individual pharmacists are running into problems trying to follow the new guidelines, he noted, because they’re dealing with a state law adopted before new federal rules took effect, in addition to limits from insurers on what they’ll pay for on prescriptions.

Amid that numbers game, the “partial-fill” mandate took effect Jan. 1, in one of the busiest times of the year for pharmacists, and pharmacies’ software systems would not allow for “partial fills,” according to Cost.

“There just weren’t capabilities to be able to do it,” he said.

Pharmacy companies with software in numerous states are dealing with Tennessee’s limits, but their systems might not allow for filling the second part of the “partial fill,” he said. In those cases, the patient might have to go back to the prescriber to have the rest of the prescription filled, he said.

Cost acknowledged penalties from the Legislature are “a possibility,” but he said such a move would put pharmacists who are trying to comply with the law in a “very bad spot.”

“I think everybody has their own policies on what they’re doing and everybody has policies on how they’re interpreting the law. The main issue that we have to work on is having those one-on-one conversations with the corporate chains,” Cost said.

National chain pharmacies are making decisions based on 50 states in terms of corporate policy, and they could set limits “more stringent” than the state’s rules for opioid prescriptions, he said.

Cost noted his group looks at the matter from the “patient perspective” and is concerned that conflicting state and federal rules and company policies could put patients in “harm’s way” and potentially keep them from having access to medication.

Topics

Cameron Sexton Larry Miller Opioid Epidemic Tennessee Pharmacists Association Walgreens Walmart
Sam Stockard

Sam Stockard

Sam Stockard is a Nashville-based reporter with more than 30 years of journalism experience as a writer, editor and columnist covering the state Legislature and Tennessee politics for The Daily Memphian.


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