TMA Challenges Walmart on Controlled Substance Policy

July 30, 2019

The Tennessee Medical Association is pushing back against a new, arbitrary policy that allows Walmart and Sam’s Club pharmacies to decide not to fill some patients’ legitimate controlled substance prescriptions.

TMA was recently copied on a letter from Walmart to one pain management specialist informing the physician that Walmart and Sam’s Club pharmacies will no longer fill the member’s Schedule II-V controlled drug prescriptions. There was no reason provided for Walmart’s decision beyond a general reference to a broadly encompassing federal regulation. The physician appealed the decision but was notified promptly that the retailer would stick to its decision. TMA has since learned that form letters were sent to other Tennessee pain specialists and other physicians across the nation.

TMA sent a letter in July to Walmart’s compliance department and lodged a complaint with the Tennessee Board of Pharmacy after hearing from additional members whose prescriptions were being denied. TMA has learned that the Board’s executive director will meet with Walmart representatives and consider whether the retail giant’s actions inappropriately interfere with the Board’s role in regulating the practice of pharmacy in Tennessee.

Walmart instituted a policy in 2018 to restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 MME maximum per day. The corporation gives no additional reasoning in its correspondence to blacklisted physicians, and TMA is not aware of any peer review or other rationale for its recent denials.

The American Medical Association has had similar correspondence on a national level but has not been able to engage Walmart in response.

Tennessee, meanwhile, has the most restrictive pain management licensure process and chronic pain prescribing oversight in the nation. Walmart’s decision is a disservice to patients because it disproportionately impacts physicians who treat chronic pain patients with opioids. TMA believes the policy should not apply to any certified pain management specialists who primarily write controlled drug prescriptions for chronic, not acute, pain and otherwise remain in compliance with all appropriate state and federal laws.

The decision by Walmart and Sam’s Club are especially problematic in rural, underserved areas where patients may not have access to any other pharmacies.

TMA encourages any members who have information or experiences to support advocacy on this issue to contact legal@tnmed.org.