Walgreens' senior managers ignored staff concerns and urged them to keep working with "pill mill" doctors over-prescribing opioid drugs, emails uncovered by the Justice Department and included in a lawsuit against the pharmacy chain allegedly show. Walgreens denies any wrongdoing. In a statement, the company said it, "will not stand by and allow the government to put our pharmacists in a no-win situation, trying to comply with 'rules' that simply do not exist."
of pharmacists." The concern was again elevated to RxIntegrity, which emailed: "As long as prescriber has an ACTIVE DEA [ Drug Enforcement Administration license] and valid state license, we ask that you use GFD to determine whether or not a script can be filled."
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Why It Matters
The Department of Justice lawsuit, filed in an Illinois federal court on January 16, said the ongoing opioid epidemic has had "devastating effects." More than 500,000 people in the United States have died from an overdose involving opioid drugs, also known as opiates, since 1999, including both prescription and illegal forms, according to the federal government's Center For Disease Control and Prevention. Walgreens operates one of the largest pharmacy chains in the United States, with more than 8,000 pharmacies, and its pharmacists fill and dispense thousands of prescriptions every day.What to Know
The DOJ has obtained emails and internal documents from Walgreens allegedly showing that since August 10, 2012, Walgreens "filled millions of invalid controlled-substance prescriptions in violation of federal law."Concerns Raised
In one December, 2013 email, the director of Walgreens' pharmacy compliance department explained that Walgreens' pharmacy chief was "convinced" that Walgreens pharmacists "are over the top with GFD"— Walgreens' Good Faith Dispensing Policy—and that Walgreens' drug sales were being hurt as a result. In other words, the pharmacy chief allegedly wanted staff to be less diligent in spotting opiate abuse because it was affecting profits.The 'Outrageous' Chicago Doctor
Walgreens' pharmacy compliance department, also known as RxIntegrity, later analyzed prescribing patterns for a Dr. Paul Madison, who practiced in the Chicago area, and determined that he continued to rank in the 99th or 100th percentile of Walgreens prescribers for dispensing oxycodone, hydrocodone, and carisoprodol. It also found that 83% of his prescriptions were for controlled substances and that he had written more than 5,000 prescriptions for hydrocodone and oxycodone in the first three months of the year.'He's Going To End Up In Jail'
Following this analysis, in November 2015, Dr. Madison was identified by RxIntegrity as one of dozens of "prescribers of concern" selected for further review by Walgreens' vice president of clinical programs & quality. That senior manager in a December 2015 email to the director of RxIntegrity, described Dr. Madison's opioid-prescribing practices as "outrageous" and concluded: "bottom line: this guy is bad, so bad that I don't really want to call him. He's going to end up in jail." The DOJ Lawsuit alleged: "Yet, despite this disturbing assessment, Walgreens did not block Dr. Madison and pharmacists continued to fill Dr. Madison's prescriptions, including his controlled-substance prescriptions. Indeed, following this December 2015 email, Walgreens pharmacists filled hundreds of Dr. Madison's prescriptions that raised one or more egregious red flags."License Stripped
Nearly a year later, on November 29, 2016, the Illinois Department of Professional and Financial Regulation suspended Dr. Madison's controlled-substance license for improperly distributing opiates. "Even after RxIntegrity was aware that Dr. Madison's Illinois license had been suspended, however, Walgreens pharmacists filled nearly a dozen of his controlled-substance prescriptions written in Illinois," the Department of Justice lawsuit alleges. In November 2018, Dr. Madison was convicted of multiple counts of health care fraud and died before sentencing.The Maryland Pill Mill
In April 2016, a Maryland pharmacy manager allegedly emailed her district manager with concerns about the Rosen-Hoffberg Rehabilitation and Pain Management Clinic, which operated at several locations in Maryland. The email in the suit said another chain pharmacy "has made it a policy not to fill" for the clinic, and that the doctors at the clinic were "under investigation with the MD Board of physicians" for over-prescribing opioids.An Alleged Business Opportunity
The pharmacy manager was allegedly concerned about a potential loss of business from the clinics, especially as more business would open up because other pharmacies were refusing to dispense for the clinics. According to the suit, the pharmacy manager emailed back: "With the increase of patients that will most likely be coming to our store and the overwhelming amount we already do from that clinic, we are a little worried [that] we would be for a policy that stopped us from filling for them."Red Flags Raised
The issue was brought to the attention of RxIntegrity, which analyzed the Rosen-Hoffberg Clinic and found that many of the clinic's prescribers ranked in the 99th or 100th percentile for oxycodone prescribing. In January 2018, another pharmacy manager emailed their district manager about the Rosen-Hoffberg Clinic. They noted that the Rosen-Hoffberg Clinic director "has been reprimanded and further charged by the Maryland Board of Physicians and Attorney General regarding negligent and excessive opioid prescribing." "[Another chain pharmacy] has also taken a stance to deny all prescriptions from this practice."Protecting Pharmacists
The pharmacy manager email continued: "I believe Walgreens should revisit this practice in order to perform their due diligence and protect the licensesof pharmacists." The concern was again elevated to RxIntegrity, which emailed: "As long as prescriber has an ACTIVE DEA [ Drug Enforcement Administration license] and valid state license, we ask that you use GFD to determine whether or not a script can be filled."
