An investigation by Attorney General Maura Healey found that some Walgreens pharmacies failed to monitor patients’ drug use patterns and didn’t use sound professional judgment when dispensing opioids and other controlled substances — a concern because of soaring overdose deaths in Massachusetts.
Walgreens agreed to pay $200,000 and follow certain procedures for dispensing opioids, in a settlement filed Wednesday in Suffolk Superior Court.
“Our records show,” Walgreens spokesman Phil Caruso said in an e-mail, “that the prescriptions in question were dispensed to patients for a legitimate medical purpose and issued by licensed practitioners,” suggesting the drugs were not diverted to the black market.
But the attorney general’s Medicaid Fraud Division found that, from 2010 through most of 2015, multiple Walgreens stores across the state failed to monitor the opioid use of some Medicaid patients who were considered high-risk. Such patients are supposed to obtain all prescriptions from only one pharmacy, and that pharmacy is required to track the patient’s pattern of prescription use.
Some of the state’s 160 Walgreens accepted cash for controlled substances from patients in the state’s Medicaid program, known as MassHealth, rather than seeking approval from the agency. In some cases, MassHealth had rejected the prescription; other times, MassHealth was never billed.
Walgreens agreed to update its policies and procedures, and train its staff, to ensure that pharmacists properly monitor and do not accept cash payments from patients deemed high risk.
The agreement follows a similar enforcement action against the pharmacy giant CVS, which in September paid $795,000 and agreed to improve procedures after Healey alleged improper dispensing of opioids.
“We’re pleased to see Walgreens joining as a partner with the payment with this agreement,” Healey said in a phone interview Wednesday. “It’s great to see them stepping up to put in place best practices.”
The $200,000 from Walgreens will be added to a youth opioid education and prevention fund set up with $500,000 of the CVS money. Healey’s office received 120 applications requesting a total of $3.9 million from the fund, but will not be able to give money to them all.
“What we see is a huge demand and huge unmet need,” Healey said. “Schools and parents want this, but many just don’t have the resources to deliver it.”
Caruso said Walgreens’ contribution to the grant fund “supports Walgreens’ ongoing commitment to combat prescription drug abuse in Massachusetts and across the US.” And he said the company “will continue to review, monitor, and reinforce the policies and procedures we already have in place, and look forward to working with the attorney general’s office to further assist in their efforts to combat opioid abuse and misuse.”
Massachusetts is among the states hit hardest by a national epidemic of opioid abuse and overdose deaths. The state Department of Public Health estimates more than 1,700 people died of drug overdoses in 2015, more than triple the number in 2010.
Most of those who died had illicit fentanyl, heroin, or tranquilizers in their systems, rather than prescription opioids. But Healey said four of five Massachusetts residents who became addicted to heroin started by taking painkiller pills, usually before age 18.
“We have a real opportunity and a real need to focus on helping to educate and prevent opioid abuse among young people,” she said.
Healey’s agreement with Walgreens also addresses the state’s Prescription Monitoring Program, a database of every prescription for a controlled substance dispensed in the state, which can alert pharmacists when someone is visiting several doctors or pharmacies, a sign of drug misuse. The agreement requires Walgreens to ensure that its pharmacists check the prescription database before dispensing certain drugs to anyone, not just people covered by MassHealth.
State law does not require pharmacists to consult the prescription database, although doctors, nurses, and others who write opioid prescriptions must do so. And Healey’s office did not have any reason to believe that Walgreens pharmacists were not using the database. But now the agreement requires they do so.
The settlement with CVS, which has 350 stores in Massachusetts, has a similar requirement. In the case of CVS, the attorney general found the chain’s pharmacists had not been routinely checking the prescription database, and before March 2013, many stores didn’t have adequate Internet access to allow them to do so. Like Walgreens, CVS was also found to have violated the MassHealth rules by accepting cash payments for controlled substances, and agreed to stop doing so.
The Walgreens settlement gives a significant boost to the attorney general’s youth education fund. That was good news for Kat Allen, coordinator of the Communities that Care Coalition of Franklin County and the North Quabbin, one of 120 grant applicants. The attorney general expects to select the grant recipients in a few weeks.
Allen said her group is seeking $20,000 to expand a program that teaches social and emotional skills, such as how to cope with anger and anxiety and how to resolve conflicts. The program is offered in seven public middle schools; the grant would expand it to elementary and high schools. She said the program has proven its effectiveness over years of research.
“When kids have those kinds of strong social skills and emotional skills, they’re way less likely to turn to substances,” Allen said.
Felice J. Freyer can be reached at email@example.com.