Was Walmart responsible for vetting opioid prescriptions?

Discussion
Photo: Walmart
Dec 23, 2020
Tom Ryan

The Trump administration on Tuesday sued Walmart for helping fuel the nation’s opioid epidemic by ignoring suspicious prescriptions. The retailer’s counterargument: the vetting of prescriptions lies primarily with the physician, not the pharmacy.

“Blaming pharmacists for not second-guessing the very doctors the Drug Enforcement Administration (DEA) approved to prescribe opioids is a transparent attempt to shift blame from DEA’s well-documented failures in keeping bad doctors from prescribing opioids in the first place,” Walmart said in response to the lawsuit.

The 160-page civil complaint, however, cites numerous incidents in which Walmart’s employees came to managers and federal authorities with “glaringly obvious red flags” about questionable prescriptions that Walmart failed to report as required to the DEA. The alleged poor screening was blamed on understaffed pharmacies and pressure on pharmacists to fill prescriptions quickly.

The suit seeks penalties that could add up to billions for thousands of violations.

“As one of the largest pharmacy chains and wholesale drug distributors in the country, Walmart had the responsibility and the means to help prevent the diversion of prescription opioids,” said Jeffrey Bossert Clark, acting assistant attorney general of the Justice Department’s civil division, in a statement. “Instead, for years, it did the opposite — filling thousands of invalid prescriptions at its pharmacies and failing to report suspicious orders of opioids and other drugs placed by those pharmacies.”

Litigation around the opioid crisis that has killed more than 400,000 Americans during the past two decades has shifted from doctors and manufacturers to pharmacy chains’ roles as both distributors and dispensers of painkillers.

In October, Walmart preemptively sued, charging justice officials were “more focused on chasing headlines than fixing the [opioid] crisis.”

On Tuesday, Walmart insisted it blocked thousands of questionable prescriptions and claimed that the federal investigation was “riddled with factual inaccuracies and cherry-picked documents taken out of context.”

The retailer stated, “By demanding pharmacists and pharmacies second-guess doctors, the Justice Department is putting pharmacists and pharmacies between a rock and a hard place with state health regulators who say they are already going too far in refusing to fill opioid prescriptions. Ultimately, patients are caught in the middle.”

DISCUSSION QUESTIONS: To what degree are pharmacies responsible for questionable prescriptions? Are there extra steps or procedures that retailers can take to resolve such conflicts between the pharmacists and the doctor-patient relationship?

Please practice The RetailWire Golden Rule when submitting your comments.
Braintrust
"If it were a liquor store not enforcing age restrictions, they wouldn’t get a pass. "
"What are the vetting processes for a script? Are there any? Seems like an AI process could address this."
"Besides, the “Trump legal team”? I mean, who would you bet on, those guys or the Walmart legal team? I rest my case, your honor."

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14 Comments on "Was Walmart responsible for vetting opioid prescriptions?"


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Cathy Hotka
BrainTrust

There are shocking stories of drug manufacturers sending tens of millions of prescriptions to tiny, 3,000-resident towns in West Virginia. Anyone with common sense could see that this was just plain wrong. Walmart and other pharmacies should have flagged this early on.

Gene Detroyer
BrainTrust

If the description noted in the complaint, “Walmart’s employees came to managers and federal authorities with ‘glaringly obvious red flags’ about questionable prescriptions that Walmart failed to report as required to the DEA,” is accurate then shame on Walmart.

I do have to wonder, though. Walmart fills less than 5 percent of the prescriptions in the U.S. CVS and Walgreens fill multiple times more. Are there any questions about how they handled the opioid prescriptions?

Tom Ryan
Staff

In May, two Ohio counties sued CVS, Rite Aid, Walgreens, Giant Eagle as well as Walmart in what was described as the first lawsuits related the opioids to target retail pharmacy chains.

Richard Hernandez
BrainTrust

I read a story yesterday in which Walmart pharmacists raised a red flag early (about people standing in lines to fill opiate prescriptions). They were told to remain silent or they would be relieved of their job. I just don’t see how this could have gone on for so long and not be exposed early on. And to Gene’s point, what about the other large pharmacies?

Bob Phibbs
BrainTrust

If it were a liquor store not enforcing age restrictions, they wouldn’t get a pass. Their own employees are quoted as knowing and trying to stop it – why did Walmart not listen to them to begin with?

Paula Rosenblum
BrainTrust

Because a prescription is different. If someone presents a valid prescription, that’s all the pharmacist should care about. It’s the equivalent of enforcing an age restriction.

Bob Phibbs
BrainTrust

It’s not like they didn’t know there was an opioid problem. It was enough to raise bells for those who are in charge of safeguarding the public that worked for the company. To pass it off and say they had a prescription negates the fact that the company had knowledge of what was going on and tried to stop it.

Paula Rosenblum
BrainTrust

I just don’t see Walmart as culpable in this case. As Cathy pointed out, the problem is way up the supply chain, but I’m not sure that’s Walmart’s problem. It’s a lack of oversight at a higher level.

On the flipside, after my knee replacement two years ago, I saw the extent to which regulators had swung too far in the other direction. The rules around how many you can get for how long are blanket, and frankly dumb. So one dumb policy was replaced by another one on the other end of the pendulum.

Lee Peterson
BrainTrust

Seems more feasible that an independent druggist might fall into a pay-for-paper trap, but Walmart? I don’t know, this feels more like unintentional incompetence or isolated evil than corporate malevolence to me.

Besides, the “Trump legal team”? I mean, who would you bet on, those guys or the Walmart legal team? I rest my case, your honor.

Ricardo Belmar
BrainTrust

If the employee claims are true as stated, then there would appear to be either gross negligence on Walmart’s part or at the very least bad decisions in ignoring an obvious problem. However Walmart isn’t wrong in saying it isn’t the pharmacist’s job to get in between doctors and their patients. Should there be better regulations in place (not necessarily more but better)? Yes, or this crisis would not have happened. That said, it seems quite odd that the federal government would single out Walmart rather than the retailers that deliver the majority of prescriptions – CVS, Walgreens, Rite Aid, and so on. Regardless of the facts and merits of the case, it certainly would appear to be singling out a big-ticket target, namely Walmart, because it generates more headlines than suing other retailers.

Joel Rubinson
BrainTrust

What are the vetting processes for a script? Are there any? Seems like an AI process could address this.

Ken Lonyai
BrainTrust

Elsewhere, I saw mention that Walmart discounted opioids as essentially a loss-leader to get shoppers into stores and store managers pressured pharmacists to fill prescriptions. If true, that’s clearly crossing the line. I can see discounting OTC products as loss-leaders but opioids are Schedule III narcotics. Discounting those to drive business is irresponsible no matter who the dispenser is. For certain classes of drugs, this case and the national crisis indicates that there need to be price floors to take competition out of the equation for products with a high potential for abuse.

Craig Sundstrom
Guest

It’s hard to judge this without knowing a little of the, you know, relevant facts. Such as what did the law require and was it followed?

It’s also unclear, to me anyway, how detectable this was. It’s not like it’s some corner drug store where the pharmacist knows everyone personally (OTOH tracking software may well be able to spot things the casual observer would be unaware of).

So until the case is actually made in trial, I’m going to go with a presumption of innocence and assume headline-chasing of the “we have to blame someone” type.

James Tenser
BrainTrust

The suit against Walmart felt a little like scapegoating to me at first, but on reflection they truly should have known better. In fact, we could argue that large pharmacy chains have a whistleblowing responsibility. As others here remind us, the sheer quantity of opioid scrips should have sent up red flags.

A corollary of retail’s Paradox of Scale tells us that many small local mistakes can add up to a very large consequence that may be hard to perceive at first. Walmart pharmacists may well have questioned tens of thousands of prescriptions, as the company states, but that represents a fraction of the excess. The question I would ask is, “Who was responsible for looking at the aggregate data?”

Walmart (along with the other large pharmacy chains) is not wrong to defend its people on the front lines, but it must also shoulder its share of the responsibility for the opioid crisis.

wpDiscuz
Braintrust
"If it were a liquor store not enforcing age restrictions, they wouldn’t get a pass. "
"What are the vetting processes for a script? Are there any? Seems like an AI process could address this."
"Besides, the “Trump legal team”? I mean, who would you bet on, those guys or the Walmart legal team? I rest my case, your honor."

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