Increased Levels of Bureaucracy Breeds Failures in Accessing Healthcare Services

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The California Medical Association is working to get legislation introduced — perhaps as early as this week — that will alleviate a problem with prescription forms that has pharmacists across the state rejecting patients who bring doctors’ orders for pain medications.

Many doctors say the problems began Jan. 2 after a new law went into effect the day before. That’s when they started receiving emails from pharmacies telling them that they had used an incorrect prescription form and that pharmacists couldn’t fill their orders until they received the correct form.

“I just got my new prescription pads (Monday) at a cost of several hundred dollars, and the change is trivial,” said Dr. Richard Buss, a family practice physician in Jackson. “At the hospital here, I was next to a doctor who was trying to send a patient home after knee surgery, and the pharmacy wouldn’t honor his prescription because they were old forms.”

The new law, known as Assembly Bill 1753, is intended to help keep opioid medications and other controlled substances out of the illicit drug trade. Carried by Assemblyman Evan Low, the measure allows the California Department of Justice to restrict the number of companies authorized to print prescription drug forms, and it requires that each form has a unique serialized number for tracking. Legislation in 2017 required other security measures for prescription forms.

Buss said the changes in the forms seem more like a change in format to him than an addition of meaningful new security measures. The old forms, he said, had serial numbers as well.

Gov. Jerry Brown signed the measure in September, but the California Medical Association told Attorney General Xavier Becerra in a letter dated Dec. 21 that updated forms were not available to physicians until the week of Dec. 17. The professional organization, which represents 43,000 doctors, said in the memo that it had concerns that doctors would not have enough time to acquire the new forms and implement the new protocols before the Jan. 1 deadline.

The Jan. 1 implementation “would result in a serious barrier to patients who must access necessary medications in a timely manner,” said Janus Norman, senior vice president for the CMA’s Center for Government Relations. He urged Becerra to work with the Medical Board of California and the California Board of Pharmacy to establish a transitional period allowing pharmacists to accept forms that do not comply.

Buss said he was frustrated because this is the second year in a row where he felt doctors were not given proper notification of changes needed in their prescription forms: “They’re just changing a prescription requirements, and then the doctors have to jump through the hoops suddenly, and I’m left with thousands of prescription blanks that are unusable, and that’s probably true for a lot of other doctors.”

No transition period was included as part of the legislation. In an email to The Sacramento Bee, Low stated that he is “committed to seeing that any legislative solution is signed into law immediately.”

On Tuesday, Anthony York, a spokesman for the California Medical Association, said the organization hoped to have legislation soon that would ensure a smoother transition to new prescription pads. He didn’t have details on the measure under consideration.

Buss said he believes that legislation affecting prescriptions should include a grace period in which pharmacists and printing companies alert doctors of the date on which their prior forms will expire.

The Medical Board of California said it tried to get the word out. On Dec. 28, it sent an email blast to all licensees notifying them of the new prescription form requirement for many controlled substances, and the agency posted messages that day about the new prescription form requirement on its Facebook and Twitter sites. On Jan. 10, it issued a joint statement with the Department of Justice and the pharmacy board.

In that statement, issued via email blast and the web, the agencies said none of them wanted to see patients denied access to necessary medications in the transition to new forms. To that end, the pharmacy board said in the statement, it would not make a priority of investigating pharmacists who determine it is in the best interest of a patient or public health to fill a prescription using last year’s prescription forms.

“Pharmacies have the option of accepting the (prescription forms) but people are so wary now of running afoul of the Board of Pharmacy that they’re just refusing them,” Buss said. “Even the prescription printers had no warning of this. There’s probably 20 to 30 organizations that print security prescriptions, and they were all rushing to get these things done.”