In the latest attempt to crack down on Florida's pain pill epidemic, CVS pharmacies have told some doctors that they no longer will fill their prescriptions for widely abused narcotic medications.
"CVS Pharmacy Inc. has become increasingly concerned with escalating reports of prescription drug abuse in Florida, especially oxycodone abuse," read the letter sent to a Florida pain specialist and provided to the St. Petersburg Times.
"We regret any inconvenience that this action may cause. However, we take our compliance obligations seriously and find it necessary to take this action at this time," the letter concludes.
While it's unclear how many doctors have received similar notices, the pain management community is buzzing about the development. The Florida Academy of Pain Medicine sent out an email alert with the letter that was sent to a Central Florida physician, one of its members, blacking out his name.
"I don't want to be subject to the scrutiny of CVS," said Dr. Jeffrey Zipper, chairman of the academy's medical affairs committee. "They've made a business decision, and from my perspective, I'm going to make a business decision to send my patients elsewhere."
In the email alert, he informed colleagues that CVS appears to "have initiated an internal program where they are profiling physicians' controlled substance prescribing habits and possibly their patients' prescriptions," wrote Zipper, a Delray Beach physician and CEO of the National Pain Institute, which has seven locations across Florida.
He said the academy member receiving the CVS notice had extensive training in pain management and had never been disciplined by state medical regulators, but did not wish to be identified.
In response to questions from the Times, CVS said in a statement that a "small" number of Florida physicians recently received the notification.
The corporation also said it had notified the U.S. Drug Enforcement Administration of its actions but declined to comment further.
CVS customers are being told about the move when they see their pharmacists. The doctors' prescriptions for other kinds of drugs still will be filled at CVS, a company spokesman said.
Some CVS pharmacies appear to be flagging prescriptions for a specific combination of medications with high potential for abuse — oxycodone, Xanax and Soma, said Ashley VanDercar, attorney and risk manager at the Tampa Pain Clinic.
The trio of a narcotic pain reliever, an antianxiety medication and a muscle relaxant has been widely prescribed at pill mills, noted VanDercar, whose clinic hasn't been the target of any CVS action.
She learned about the practice from another local pain physician who had not received a letter from CVS but learned through patients that he was being scrutinized for prescribing this combination.
The CVS effort to target certain physicians appears to be unique among pharmacies, although pharmacists are professionally obligated not to fill prescriptions they find questionable, according to the state Department of Health.
The Florida Pharmacy Association was unaware of any other efforts like CVS's. But the pharmacists it represents have become increasingly cautious about filling prescriptions for medications now responsible for more than seven overdose deaths a day, more than from heroin and cocaine combined.
"With all the activity looking at Florida as perhaps a strike zone for the illegal use of legal drugs, it has created a considerable amount of anxiety among pharmacy providers," said Michael Jackson, executive vice president and CEO of the pharmacy association. "They are being more careful in working with their patients and ensuring that their patients are being monitored."
But some pain management providers say the crackdown has gone too far.
"It's pretty damning of CVS to be sending out a letter like that," said Paul Sloan, who owns pain clinics in Venice and Fort Myers and heads the Florida Society of Pain Management Providers. "You are reaching an epidemic proportion of patients being denied their medications. It has gone so far to the extreme that you are crucifying legitimate patients."
Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.