From: ever_kleer Newsgroups: alt.drugs.hard Subject: Re: prescription prpfiles??? Date: Sun, 08 Mar 1998 07:10:16 -0600 In article <19980307192000.OAA23485@ladder03.news.aol.com>, (Olivia etc) wrote: [] > Big Brother's Prescription Computers are linked > thoughout the country. It is an easy way for docs > and/or pharmacists to get their info. [] Well, that's only partly true. When you purchase an Rx from a pharmacy, its records are typically kept online (at store level in most cases, but with some national chains like Walgreen's centrally as well) for about 18 months before being sent offline to microfiche or other appropriate media. This fiche, for each location, is kept at the pharmacy and is required by both state and federal regulatory bodies. The length of on-site retention is approximately 7 years, though it, and the time before archival to fiche varies from operator to operator and state to state. (Typically no less than 1 year online to accomodate patient summaries for tax season). Of course, any triplicates for Schedule II meds are administered concurrently, and subject to their own regulations as mandated by jurisdiction. In SOME locals, pharmacies are required to send information on SOME medications to the state for highly abused Schedule III narcotics (i.e. Vicodin et al) In these states, as patient confiendtiality still prevails, the information is sent identified by an arbitrary patient ID number. The overall goal is to trend potentailly over-prescribing doctors and abnormal Rx activity by store, there has been work done into looking into trend by identifier, to help search out drug-shoppers and the like. While this may be effective, (as some ID is required in these states to pick up the Rx), the issue of privacy is parmamount and the state does not yet meet the burden for an unwarrented search in this manner. This is fairly recent, but it may have changed since. Beyond that, there is no way for one pharmacy to legitimately arbitrarily check the records of another, unless it is part of the same chain affiliation. They are not connected either logically or physically. Even at state or fed level, save Schedule II (triplicates), there is no means to do so. Even as technology progresses, the patient rights prevail. Unfortunately, nothing can overcome an unscrupulous (even more than the patient ;^) ) pharmacist from disclosing what he should not. There are some exceptions, however. A doctor, in most localities, can check on the last fill date of a particular Rx for a given patient. Under the premise of protecting from interaction/overlap/abuse, the pharmacist may comply, but may not reveal the other doctor in question. Again, this varies from state to state, but this is by en large the most common scenario. The second potential gotcha comes from insurance carriers. While most recreational users pay cash, some have really good insurance. This is where you must beware of the insurance carriers. Most pharmacies now use online adjudication to collect from insurance companies. Coverage is verified and paid the second the Rx is processed in the computer. While the store's Rx system typically checks the sig against dispensed quantity to determine if a refill is "too soon", the pharmacist, except in Schedule II's which have no refills should still fill a refill, or a new Rx of same type. However, the insurance companies systems are much more sophisticated, (it's their money on the line so you can BET they're paying attention), and their systems will almost definitely outright refuse to pay the claim if too soon or if dosages overlap. This will happen REGARDLESS if there are different pharmacies or chains being used, as the claims are done immediately outside the store, and central to the insurance carrier. If the drug is in the plan formulary, and the patient hasn't had an Rx filled there before, there SHOULD be no reason to deny the claim except unless of course, one was too-recently filled elsewhere. With highly-aboused C-III's, this really sets the bells off to the RPh. With a C-II, you can expect a series of phone calls (with varying consequence) to follow. So there's a little peek inside what's REALLY going on *back there*. Remember that this applies to most states and companies but can change from locale to locale. (Software programmer who has written a bunch of the stuff that does this other stuff ;^) and has had to include all this logic to handle all this unecessary ugliness) But all in all, with a little discretion, self-confidence, and avoiding anything that might set off a bell in your own head, you should be just fine. Ever Kleer. ==================================================================== From: ever_kleer Newsgroups: alt.drugs.hard Subject: Re: prescription prpfiles??? Date: Tue, 10 Mar 1998 13:55:11 -0600 In article <19980310134601.IAA12771@ladder02.news.aol.com>, lectrklady@aol.com (LectrkLady) wrote: > Recently while haveing A tooth pulled my dentist said "no dilaudid this > time, the pharmacie said they would not fill it anyway". Like there are > no other pharmacies around. (he gave me tylox instead). Yah, i know. > He then went on to say, before he wrote the script, that he was waiting > for my prescription profile so he could see what I was takeung. > > MY QUESTION IS THIS---- Can they do this and how?>>> > If it is a dentist they can do swabbings from your mouth and get a tox > screen from that. Now aint that progress? The only records that the pharmacist can access online are those for your prescription history at that particular pharmacy. In some cases, the pharmacy may access your records chain-wide, but only for that particular pharmacy's affiliation. It depends on their system architecture. Some companies use a centralized, while others are distributed. Even for those that are distributed, they typically do NOT offer their stores the ability to query all chainwide Rx's for a given customer. However, most can look at another store's records online, on a store by store basis. This is for the purpose of electronic Rx transfer, and the pharmacy must look into a specific store to get the info. (i.e. there is no automated means of going store-by- store through the entire chain, but theoretically, it could be done by going through the entire store roster one at a time) Although without warrant, or your direction, there are legalities that protect you, even within different stores of the same chain. The state does track Schedule II usage. So does each pharmacy at store-level. The doc can request your Rx "profile" from a pharmacy. This is not a "formal" profile, but instead, more along the lines of finding drugs that might overlap or interact with what he might prescribe. It is under these auspices that he can find out what you have been taking. But, he cannot (legally) ask who prescribed it, as that is part of patient confidentiality that does not apply to protecting you from adverse reactions, etc, yada yada. I don't know if doc's can request your C-II usage from the state. Indeed, these are the ONLY drugs that are formally tracked to an individual by the governement. I susepct there would be a need (akin to probable cause) to access this info unless you are a government agent, but this is outside of my area of specific knowledge. Some docs and pharmacies do keep internal list of "seekers" and potential abusers. While each pharmacy and doc can keep their own internally, it is absolutely not legal for them to share their lists with other docs, or even other pharmacies within the same chain. Besides the patient/doc confidentiality relationship, if this info is ever disclosed, it could sure be construed by some as slander or libel. The theory is if its internal, it isn't intended to be made available publicly. In reality, though, we all know this exchange of info, in many cases does occur. But, believe it or not, pharmacies are actually adamant about NOT sharing this info, especially the big ones, because of the potential liability and credibility hit. Also, just imagine if the wrong insurance member hears (or thinks) that any of his records may be shared? With as much Rx business determined by insurance plans (around 75%) the potential loss of revenue is TOO great. The pharmacist him/herself may not be on your side, but ironically, although not intentionally, the chain may be on your side here. I guess the bottom line is that the doc holds the pen and the pad. His willingness to dispense is based in HUGE part on his comfort-level. If he wants your profile (whatever that means), before he writes, unless you protest, he's probably gonna ask for whatever he can find, and without your disapproval, is probably covered in doing so. In reality, though, if you separate your pharmacies and use different chains in different areas, unless he goes to the state (again I don't know the nuts and bolts or their reporting process/policies), he is most probably going to only find out what went on at the pharmacy he knows about. Rotsa ruck! Ever_Kleer ==================================================================== From: "Dr. C.M. Faubert" Newsgroups: alt.drugs.hard Subject: Re: Tylenol extraction Date: Sun, 06 Sep 1998 04:15:51 -0400 [...] People here appear unsure as to the how/why they have such difficulty with some doctors and not with others or what they are doing that makes the situation change suddenly - does the doctor think they are seeking, etc.? The answer is a lot more simple than any of you appear to realize. In 1993, the Federal Government encouraged the State's Medical Boards to adopt a system developed by the Fed to check and control drug abuse. This system is not destructive, but it is damn inconvenient. All but 7 States have adopted it. It works like this: You go to a Doctor, he writes a script for narcotics. He charts you. You get your script filled. Three things have just happened that you are not aware of: 1: The doctor has logged the Schedule II Script in his Log Book. 2: The Pharmacy has logged the Schedule II Script in its "Weekly Return" 3: The Pharmacy has reported the Schedule II to your Health Insurance Company (if you have one). You happily go on your way. If you are abusing the medication, you will run out long before the prescription is refillable. So you probably won't go back to the original doctor. You go to a different doctor. You get another script. If you take that script to the same pharmacy, and you have health/perscription insurance, you may discover that they will refuse to fill it because: 1: You just had a script for narcotics filled and it is too early for a new one; or 2: The insurance companies computer kicks that same information back and refuses to cover the script until X date. Having discovered this, you are careful to go to a DIFFERENT Pharmacy, or to not use your Health/perscription insurance to have it filled. You have developed a system. Perhaps you are lucky a lot, perhaps not. Months go by. Suddenly none of the Doctors who have been scripting you will do it. You wonder what it is that you did wrong? Did you "give yourself away"? You didn't give yourself away. The system caught up with you. In all but 7 States, the Pharmacy sends in a "Weekly Return" - that is a registry of all of the controlled substance and Schedule II scripts that they filled. It includes the DEA number of the prescribing physician and your Identification in the form of, at a MINIMUM, your birth date and full name - but they TRY to get your SSAN as well because that makes it a LOT easier to track you. Here's what happened. Bi-annually, the State S2 Control Board computer reviews ALL of the Doctors in that State that are licensed to prescribe narcotics. This review takes the form of the following: 1: Total number of prescriptions written by DEA Number XXXXXX Is the number unusually high? If yes, the system flags that Dr. and a letter is sent (usually a form letter) asking why he wrote so many controlled prescriptions that period. 2: More than 3 Prescriptions for Person X; OR - More than 1 Physician wrote a S2 for person X This is what got you "caught" - this type of flag is handled by a HUMAN. A caseworker is assigned that Dr. and he/she receives a very personal letter that states the following information: That he/she wrote X number of prescriptions for patient John Doe, AND that Dr. Smith in Pleasanton wrote X number, Dr. Jones in Bigcity wrote X number (etc.). The caseworker wants to see ALL of the paperwork documenting the condition of the patient and/or the specific injury. None of the physicians like these letters. They especially do not like to discover that you have been shopping them - because you NEVER mentioned the scripts you got from the other doctors - and now it is obvious to the doctor AND the State that you have been shopping narcotics. You have just created a paperwork nightmare for every physician in that State that Rx's you an S2. Dentists, Surgeons, G.P.'s, it doesn't matter. They ALL now have to explain why they did that. If they are lucky there will only be two or three exchanges of letters. If they are UNLUCKY, they may have been shopped by more than a handful of "seekers" in which case they can expect to be sanctioned. What does sanctioning mean? It could take any form, but the most often used sanctions are: 1: Prior Permission - a second doctor in the practice must be consulted and your chart reviewed AND signed-off by the partner before a script for narcotics can be written by the "sanctioned" doctor. That doesn't apply to just YOU. It applies to ANY s2 script. No matter what the circumstances are. End result? You have embarrassed the doctor. They are sure to dislike you - and anyone else that ever shows up that they might THINK is a seeker. You just alienated a doctor and possibly added to the pain that a person with a real pain-causing injury must suffer in the future because that doc only wants to script darvocet or T-3's from now on. 2: Temporary suspension of s2 persription license - this is to "punish as a lesson" and the result is that for 30 or 90 days, that Doctor can not write a s2 script. If that doctor happens to work in an ER - well, they just lost their job because in order to work in an ER they have to have the ability to write unrestricted. You just cost a doctor their job! [...]