Pharmacists can legally refuse to fill prescriptions

Patients have reported pharmacists refusing to fill out prescriptions because their medicines could be used for abortions. We explain what obligations pharmacists have.

Because state bans on abortion were lifted following the Supreme Court decision in Roe v. Wade to go into effect, patients in some states have reported new difficulties acquiring certain prescribed medications for unrelated medical conditions.

Some have said their pharmacist refused to fill their prescription for drugs like methotrexate because the drug could theoretically be used for an abortion, even if it is not the reason You take the drug.

but can a pharmacist legally refuse to give you the drugs a doctor prescribed?

THE QUESTION

Can pharmacists refuse a prescription?

THE SOURCES

THE ANSWER

This is true.

Yes, pharmacists can legally refuse to issue a prescription.

WHAT WE FOUND

Just as physicians have the power to decide whether or not to prescribe a drug, pharmacists are given professional discretion to fill or not fill prescriptions. There are a variety of reasons a pharmacist might refuse to dispense a drug, including safety concerns, legal concerns, or even personal objections in some states.

For example, it could be a suspiciously high dose of an opioid from an unknown patient or physician, in which case federal law requires the pharmacist to exercise discretion when providing a controlled substance.

Or a prescribed medication could have negative interactions with other medications the patient is taking.

Or the prescription contains an obvious error or missing information that the pharmacist needs to clarify with the doctor before filling it out.

In some cases, pharmacists may also have leeway to refuse medication based on their own personal beliefs; The extent of this latitude varies by state.

“Pharmacists are not machines. They always use their judgment when dispensing,” said Donald Miller, professor of pharmaceutical practice at North Dakota State University. “We have to do what is right for the patient. Most of the time it is correct to fill out the prescription as written, but often it is correct not to fill it out or, more often, to clarify it.”

“There can be any number of problems with a prescription, then the pharmacist has to say, ‘Wait a minute, I can’t fill that right now. I need to call your doctor and talk about alternatives, whatever the case may be,” he said.

Anna Legreid Dopp of the American Society of Health-System Pharmacists says there are five key aspects of a prescription that pharmacists should double-check. You have to make sure “it’s the right patient, the right drug, the right dose, the right way – how they take that drug – and then the right time,” she said.

This confidentiality obligation is expressly regulated in many state laws.

For example, a section of New Jersey statutes relating to the state pharmacy board and the regulation of pharmacy practice states: “A pharmacist must use independent professional judgment in dispensing or refilling a prescription or order of medication. When deciding to dispense or refill a prescription or medication order, the pharmacist’s decision must not be arbitrary but must be based on professional experience, knowledge or available reference materials.”

Oregon state law has a similar section: “A pharmacist licensed by the Board to practice pharmacy has a duty to exercise that degree of care, skill, diligence and professional judgment required of an ordinarily diligent pharmacist among the same or similar circumstances.”

In some states, pharmacists even have the ability to refuse a prescription because of moral or personal objections to the drug. Others, like New Jersey, have explicit laws prohibiting the practice. Many have laws that say pharmacists must refer the patient to either a colleague or another pharmacist if they don’t want to fill a prescription, but some states don’t. Pharmacy chains like Walgreens often have corporate policies that require pharmacists to make referrals.

Personal objections from pharmacists are not the only obstacle for some patients in states with bans on abortion. Recent reports of refusals say pharmacists are refusing the drug because they fear legal repercussions if they offer it.

For example, methotrexate is a drug commonly used to treat a variety of conditions, including rheumatoid arthritis. But in high doses it can be used to treat ectopic pregnancy by terminating it. That means it’s classified as an abortion drug in some states, potentially exposing pharmacists to legal consequences.

“We don’t know if the impact will be felt now when a clinician tries to make these decisions, or if they will be prosecuted 10 years from now,” Dopp said.

To complicate matters further, the federal government issued guidance that refusing medication could violate constitutional protections against unequal treatment of women or people with disabilities.

“In some cases we see a risk that the pharmacist will be disciplined or held legally liable for doing something at the state level, but then also held legally liable for not doing something,” Dopp said. “It’s a really difficult place to practice and it’s not in the best interests of patients.”

However, experts say there are ways for patients to potentially smooth out these types of road bumps. First, have your doctor write the reason for the prescription on the note to the pharmacy so there is no confusion as to whether it is being used for an abortion. Second, establish a relationship with your pharmacist so that they already know who you are and what you are using the medicine for.

“As long as there’s a reasonable expectation that the prescription is legitimate, you should be fine. I think pharmacies refusing to fill this is mostly fear and confusion and overreaction,” Miller said. “I understand the fear … but I think using your professional judgment appropriately for the good of this patient is a really ironclad defense.”

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Alley Einstein

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