November 7, 2019
Five pharmacy chains ordered 33 billion pills containing oxycodone and hydrocodone from 2006 through 2012. This accounts for almost half of the prescription pain pills distributed in the United States, according to a Washington Post analysis of data compiled by the Drug Enforcement Administration. Below are statements issued by the five pharmacy chains.
At height of crisis, Walgreens handled nearly one in five of the most addictive opioids
Statement on Oct. 15, 2019: Walgreens is a company of pharmacists who live and work in the communities they serve all across America. Our pharmacists are highly educated and trained professionals who are committed to filling prescriptions that meet the legitimate medical needs of their patients. We equip our pharmacists with robust policies and procedures, as well as state-of-the-art systems, to aid them in exercising their best professional judgment when assisting patients. Our pharmacists always evaluate the patient, the prescriber, the drug, the applicable law, and the surrounding circumstances prior to making an appropriate professional decision whether to fill a prescription for a controlled substance.
However, prescriptions are written by doctors based on their medical training, experience and clinical judgment, relying on their examination of the patient, diagnosis and knowledge of the patient’s medical history. When a patient presents a prescription that gives the pharmacist no reason to question its legitimacy, the pharmacist is obligated to fill the prescription exactly as written by the doctor.
We take great pride in the judgment and patient care of our 28,000 pharmacists. In the event of a rare and isolated instance when we learn of an employee acting improperly, we act swiftly to address the matter and cooperate fully with law enforcement. Our pharmacists also routinely cooperate with law enforcement investigations of the diversion of controlled substances, and report customers suspected of improper behavior.
Walgreens did not manufacture prescription opioid medications. Walgreens never marketed or promoted opioid medications. Walgreens also has not distributed prescription controlled substances since 2014.
Before 2014, we only distributed such medications to our own chain of pharmacies, staffed by our own pharmacy professionals. In this way, Walgreens is unlike any of the other distributors involved in the national opioid litigation. Specifically, Walgreens never distributed opioids to pain clinics, internet pharmacies or the “pill mills” that fueled the national crisis.
During the time period when Walgreens distributed controlled substances to its own pharmacies, our distribution center employees and pharmacy professionals were incredibly diligent and careful to ensure that (1) our pharmacies had medications in stock when patients needed them and (2) our pharmacies were not involved in the diversion of controlled substances.
This is important to keep in mind when considering very isolated instances of non-compliance, as well as the numbers that have been published about the volume of medication certain companies distributed. Context is important:
First, individual pharmacies have very different needs and ordering patterns vary depending on a number of different factors, including proximity to emergency rooms, surgical centers, and other sources of prescriptions for pain treatment; whether they offer 24-hour service; and the amount and type of local pharmacy competition. It is completely reasonable and expected that some stores will require greater quantities or place orders more frequently than others in order to fill legitimate prescriptions. Of course, one store will always be the highest volume store, just like one store will always be the lowest volume store.
Second, the market share information contained in the publicly available ARCOS data set is misleading because it covers only a segment of time (2006-2012) that ended seven years ago, before Walgreens stopped distributing controlled substances to its own pharmacies. Moreover, volume alone – particularly shorn of any meaningful context – does not equal diversion. The mere fact that Walgreens distributed any given volume of medications to any given pharmacy does not mean that the pharmacy filled any prescriptions it should not have filled. Again, we proudly stand by our pharmacy professionals and their record of professional judgment and patient care.
Walgreens has also played a key role in combatting the national opioid crisis, launching a proactive, ongoing and multi-million dollar initiative to help reduce the rate of overdose and the misuse of medications. In an effort to save lives, we worked to change state laws and regulations in seven states to allow pharmacies to dispense the overdose antagonist naloxone without a prescription. Today, naloxone is available in all Walgreens pharmacies in the U.S. and Puerto Rico without a prescription.
To reduce the misuse of medications, we provide year-round drug disposal options in all of our pharmacies at no cost to patients. Our safe medication disposal kiosk program has collected and disposed of more than 885 tons of unwanted medications to date, and we also offer DisposeRx packets that allow for medications to be safely disposed of at home. Through a collaboration with Google, people can quickly and easily find the nearest Walgreens with a safe medication disposal kiosk by searching online for “drug drop off near me” or “medication disposal near me.” Walgreens also is a regular participant in National Prescription Drug Take Back Days sponsored by the Drug Enforcement Administration, where select Walgreens stores throughout the country serve as collection points for law enforcement to collect unwanted, unused or expired medications for safe disposal.
We have also expanded the use of secure time delay safes, now installed in more than 8,600 of our pharmacies. The safes are designed to prevent diversion of controlled substances by averting the accessibility of narcotic medications by unauthorized individuals.
Walgreens has educated more than 130,000 youths across the country on the opioid epidemic and steps they can take to fight the epidemic, including how to dispose of unwanted medications, through its #ItEndsWithUs campaign (www.walgreens.com/itendswithus). The campaign engages youth at WE Day events, encouraging them to take action and safely discard their unwanted medications. It also offers resources to teens - at events and online - on how to spread awareness about the opioid crisis in their community and amplify the message via social media.
Walgreens, and our national network of community pharmacists, will continue to be deeply committed to working on solutions to the opioid epidemic, and to best serving the health needs of our customers and patients.
Statement on Oct 21, 2019: The allegations against Walgreens are very different. We never manufactured, marketed or wholesaled prescription Opioid medications. Our pharmacists have always been committed to serving patients in the communities where they live and work. Walgreens is completely unlike the wholesalers involved in the national opioid litigation. Before 2014, Walgreens delivered opioid medications – among many other types of medications – only to our own pharmacies, staffed by our own pharmacy professionals. We never sold opioid medications to pain clinics, internet pharmacies or the “pill mills” that fueled the national opioid crisis. Additionally, Walgreens never manufactured prescription opioid medications. We never marketed or promoted opioid medications. We never prescribed any opioid medications. Walgreens was not a wholesaler of opioid medications.
Statements on Oct. 25, 2019, about individual Walgreens pharmacies:
Modesto, Calif. pharmacy: Walgreens thoroughly investigated concerns regarding this Modesto pharmacy after Cardinal raised them. We found that the pharmacy was fully complying with all applicable internal policies and procedures for filling prescriptions for controlled substances. The pharmacy permit for this location has not been disciplined by the California Board of Pharmacy.
In raising its concerns, it appears that Cardinal was unaware that the Modesto pharmacy is within five miles of two hospitals, multiple surgery centers and other sources of prescriptions for pain treatment, or that this location was also used by the local hospice, all of which drove higher than expected demand for prescription pain medications. The legitimate demand created by these lawful uses of pain medication demonstrate that volume alone does not establish diversion and that a rush to judgment can result in real harm to patients in need. During the time when Cardinal was completing its follow-up on the issues it had raised, the Modesto pharmacy relied on inter-store shipments in order to continue meeting the legitimate prescription needs of its patients.
Greenville, N.C., pharmacy: The exchange between Ms. Haynes and Mr. Mills indicates that her PDQ order was not filled, and shows Mr. Mills reminding Ms. Haynes that a PDQ order was not an appropriate solution to her pharmacy’s inventory and ordering issues. The exchange also makes clear that there were real world, unintended consequences to Walgreens enforcing order limits at its pharmacies. Here, Ms. Haynes points out that her pharmacy is directly across the street from a major hospital where the emergency medicine doctor was writing many legitimate prescriptions for medications containing oxycodone, and that she is being forced to turn away patients with legitimate and immediate medical needs as the result of her inability to order sufficient quantities. No pharmacist wants to turn away a patient in severe pain with an immediate need for properly prescribed pain treatment.
Individual pharmacies have very different needs, and ordering patterns vary depending on all sorts of factors, including proximity to emergency rooms, surgical centers, and other sources of prescriptions for pain treatment; whether they offer 24-hour service; and the amount and type of local pharmacy competition. It is completely reasonable and expected that some stores will require greater quantities or place orders more frequently than others in order to fill legitimate prescriptions. Of course, one store will always be the highest volume store, just like one store will always be the lowest volume store. The Greenville pharmacy’s orders were a legitimate reflection of the demands caused by its particular location and market, and Walgreens is unaware of any diversion of prescription pain medication at that pharmacy.
Statement on Nov. 6, 2019, about bonus payments to pharmacists:
Prior to the company eliminating dispensing volume as a factor in calculating bonus payments, volume was but one of many factors taken into account. This change had a very limited impact on compensation for our pharmacy professionals. In fact, dispensing volume criteria accounted for one percent or less of the average pharmacist total compensation when the factor was still in place. It’s also important to note that the dispensing volume compensation factor was for all medications, not for opioid medications generally or Oxycodone specifically.
The nominal compensation factor in question in no way incentivized pharmacists to inappropriately fill prescriptions for any medication. Assertions to the contrary fail to reflect our pharmacists’ high integrity, professional judgment and commitment to serving the legitimate medical needs of patients.
CVS: Opioids are made by drug manufacturers, not pharmacies. Opioid prescriptions are written by physicians, not pharmacists, and there are a number of safeguards in place to prevent pills from being improperly dispensed at the pharmacy counter. CVS Health has never distributed Schedule II products – which include oxycodone – and stopped distributing hydrocodone products when they were reclassified as Schedule II by the Drug Enforcement Administration in 2014. In addition, we never sold or distributed opioids to the “pill mills” or other illegal operations that played a major role in creating a public health crisis.
Walmart: Declined to comment.
Rite Aid: We do not comment on pending litigation.
Kroger: We do not comment on matters that involve pending litigation.