Skip

Can a pharmacist refuse to dispense antibiotics?
June 8, 2011 9:03 AM   Subscribe

A friend of mine went to fill a prescription for doxycycline for Lyme Disease. The pharmacist refused to give it to her unless she had a pregnancy test. Is this legal in New York State? If not what can be done about it?
posted by vim876 to Law & Government (25 answers total) 1 user marked this as a favorite
 
I know that you can't get accutane without having pregnancy tests, too, so I'd be surprised if this is illegal, as the drug causes pretty serious birth defects.
posted by Grither at 9:05 AM on June 8, 2011


I don't know about Lyme disease medication, but per the FDA, some acne medications (Accutane for one) cannot legally be dispensed without two negative pregnancy tests because the consequences for the fetus/pregnancy are horrific. I am unfamiliar with a similar restriction for other drugs, but states can--in some circumstances--impose additional regulations on behavior restricted by federal rules, regulations and law.

The solution is to take the pregnancy test.
posted by crush-onastick at 9:08 AM on June 8, 2011


I think this falls into what the pharmacist should and must do. Remember the court cases surrounding pharmacists refusing to provide Plan-B?

I'd find a different pharmacist

[On Preview]
Does anyone know if they want you to bring the pee-sticks to them? couldn't you just have a friend do it? Or do they actually want the test done by a doctor?
posted by zombieApoc at 9:10 AM on June 8, 2011


Seconding crush-onastick. This isn't some puritanical pharmacist who's trying to slut-shame your friend -- this is a medical professional who is looking out for your friend's best interests.
posted by Etrigan at 9:10 AM on June 8, 2011


Well, if it was legally necessary for her to have had a pregnancy test before being prescribed the medication, her doctor would have required her to take the test. Unless it's a terrible doctor, which is another problem. I've never heard of someone peeing on a stick *specifically for the pharmacist.*

I would think the pharmacist needs to call the doctor if s/he has a concern about whether your friend has taken or needs to take a pregnancy test. Lyme disease is no joke and it's pretty serious to withhold her medication, IMO.
posted by Medieval Maven at 9:11 AM on June 8, 2011 [17 favorites]


Doxy is a tetracycline-class antibiotic that has been shown to cause fetal skull abnormalities in animals (no human trials have been done, at least that I can see). Also, children of mothers who took doxy while pregnant often have yellowing or browning of the adult teeth.

Now, I don't know the legalities of this, but your friend's doctor should and should be able to fix this with either a pregnancy test or an order saying she's on a reliable method of birth control (whether that is hormonal or abstinence, etc.). Or, if it's not legal, her doctor should be able to straighten it out with the pharmacy.

And the pharmacist should have told her what the deal was. If he/she refused to fill the script without any justification, I'd seek a different pharmacy based on "bedside manner" alone.
posted by cooker girl at 9:14 AM on June 8, 2011


I am not a doctor, but a quick google search for "doxycycline preganncy test" (no quote marks) does not give any information as to whether a pregnancy test is required before dispensing this particular drug. In the case of Accutane, "accutane pregnancy test" (no quote marks) directly results in the relevant FDA rules.

Yes, doxycycline is a pregnancy category D drug, which as far as I can tell does not require a pregnancy test. Aspirin is also a category D drug.
posted by muddgirl at 9:18 AM on June 8, 2011


To clarify, I am not concerned about her immediate well-being. My friend already found a different pharmacist. I am concerned because the idea that one should have to take a pregnancy test because some pharmacist thinks its their god-given right to refuse medication is terrifying. Accutane is one thing; there's a federal law, and the birth defects involved are severe and extensive. (However, I believe the prescriber [the one who went to med school], not the pharmacist, is responsible for making sure you have the necessary tests.) But other drugs? Can pharmacists just make you get a pregnancy test for any drug they please, just because you're female?
posted by vim876 at 9:24 AM on June 8, 2011


Can pharmacists just make you get a pregnancy test for any drug they please, just because you're female?

No, but as statolith indicates, doxycycline is a Pregnancy Category D antibiotic. He's just covering himself, and there's no reason to think that he can't do this.
posted by valkyryn at 9:31 AM on June 8, 2011


vim876, just want to say that I totally agree w/ you. Perhaps your friend should mention this incident to her doctor? S/he might be interested to know that a pharmacist is interfering in the dispensing of their prescriptions (or might tell you that this is to be expected, I don't know).
posted by statolith at 9:33 AM on June 8, 2011 [2 favorites]


Pharmacists can refuse to fill an Rx if they have reason to believe the prescribing doctor made an error like failing to check for pregnancy. However, the primary responsibility for that check is on the doctor, not the pharmacist. The pharmacist was being weird unless they had reason to think the doc screwed up.
posted by slow graffiti at 9:35 AM on June 8, 2011 [1 favorite]


I agree that the pharmacist is often a second set of eyes when it comes to drug interactions/side effects/etc, and it's his or her responsibility to question the filling of a prescription if it seems warranted. Doctors make mistakes all the time, and drugs are a pharmacist's specialty. I do feel that this pharmacist should have called the dr's office rather than simply refuse the medication.
posted by DrGirlfriend at 9:38 AM on June 8, 2011 [2 favorites]


Also, I've volunteered in a hospital pharmacy and accepted protocol in these cases is usually to call the doctor to clarify, not to just send the person home without needed medication or make them prove they're not pregnant right then and there.
posted by slow graffiti at 9:44 AM on June 8, 2011


You all are being extremely helpful. Thanks for that. Let me get this straight. If a woman goes to a pharmacy to get, say, a prescription-strength dose of aspirin (Category D), the pharmacist is legally able to refuse to give it to her without a pregnancy test?
posted by vim876 at 9:55 AM on June 8, 2011


I am a doctor. I prescribe doxycycline and other drugs in both category D and X. There is no standard of care I'm aware of that requires a pregnancy test prior to prescribing this drug (though it may be a good idea in selected cases).

In any event, what was done by the pharmacist strikes me as absurd and inappropriate -- though I am not a pharmacist, I can not speak to whether it is within their legal rights, and this may go on under my nose more frequently than I suspect.
posted by drpynchon at 9:57 AM on June 8, 2011 [8 favorites]


Recently, I was denied a prescription because the doctor had not written full instructions on the prescription itself (despite having the same medication prescribed in the same way for over three years). The explanation was that if they dispense the Rx, they are legally responsible if it is taken incorrectly. As much as I argued, they refused to fill it because it was not correctly filled out.

It's not an exact analogy, but it does seem feasible that if the pharmacist was worried about their liability, they could refuse to fill it.

However, on principle, I agree with drpynchon that their behaviour in this case was absurd and over the line of what they should be able to do.
posted by guster4lovers at 10:15 AM on June 8, 2011


Write the New York Office of the Professions and ask them whether this is OK.
posted by grouse at 10:16 AM on June 8, 2011 [3 favorites]


Recently, I was denied a prescription because the doctor had not written full instructions on the prescription itself (despite having the same medication prescribed in the same way for over three years). The explanation was that if they dispense the Rx, they are legally responsible if it is taken incorrectly. As much as I argued, they refused to fill it because it was not correctly filled out.


It is actually against the law to fill a prescription that has missing/incomplete directions. They weren't just being shitty to you.
posted by asockpuppet at 11:06 AM on June 8, 2011 [1 favorite]


I'm wondering if the pharmacist in question has been sued in the past by someone who suffered ill effects from a medication they dispensed. They are probably just trying to protect themselves legally.
posted by something something at 11:22 AM on June 8, 2011


I've been denied prescriptions a few times.

Once was because the pharmacist couldn't quite read the physician's writing, and though I knew the dose in question was 20mg, they wanted verbal confirmation from the physician over the phone.

Another time, the prescription was for Keflex or Ceftin, some antibiotic anyway, and as I am severely allergic to penicillin and sulfa, the pharmacist wouldn't fill the prescription unless, again, the doctor verbally confirmed that yes, that's what he meant to give me.

I'm sure your friend must have been embarrassed and angry when she couldn't get the treatment she needed. The pharmacist handled this badly, but as others said, he's just trying to protect himself against any future liability. I'm older and wiser (and bitchier) than I used to be, so if I were faced with this situation, I'd make them give me a free OTC pregnancy test at least. Or, hey, some pharmacies have clinics on-site. She needs those meds. It's a stupid rule, and I'd complain about it, but I wouldn't leave without the medication.

(Just a thought: There's no delicate way to ask this, but is your friend perhaps a little overweight? Men can be complete idiots when they see a woman who carries weight around her middle--we've all known women, I'm sure, who have gotten the wildly inappropriate, "Are you pregnant?" from a stranger. It could be that the pharmacist made a stupid assumption and based his refusal to give her the Rx on that.)
posted by misha at 11:38 AM on June 8, 2011


misha - that doesn't seem to matter, given that pregnancy category D drugs can be prescribed to pregnant women
potential benefits may warrant use of the drug in pregnant women despite potential risks.
posted by muddgirl at 11:41 AM on June 8, 2011 [1 favorite]


My understanding is that different state laws allow a pharmacist to refuse to dispense medication, but usually this is because you suspect the person is abusing the drug, or the dosage seems wrong, or it might interact badly with another drug they are currently taking, or the prescription is incomplete, etc. So you can refuse for 'professional or medical considerations'. So, I don't think it's as clean cut as:

"If a woman goes to a pharmacy to get, say, a prescription-strength dose of aspirin (Category D), the pharmacist is legally able to refuse to give it to her without a pregnancy test?"

Because it seems like it depends. For all we know, your friend might have appeared pregnant. Though, even if she didn't, the pharmacist could possibly claim that they were refusing her for professional or medical considerations. But I think where their argument would break down is in their response. The appropriate response is to call the physician. For all the pharmacist knows, it is actually impossible for your friend to get pregnant (which might be the reason why her doctor didn't get a pregnancy test done), or whatever. The pharmacist should have called, or articulated the law/policy they were citing to refuse the medication. They could have handled it better.
posted by anitanita at 11:45 AM on June 8, 2011


I wonder if the pharmacist believes he has an ethical problem with filling the prescription without a test. I know that there have been pharmacists who took a stand against filling prescriptions for the morning after pill. Obviously, that's a very different type of medicine, but maybe this situation is an extension of that thinking? There were some court cases about this several years ago, but I don't remember the outcomes per state. I think the pharmacists in Texas lost their jobs, and/but Target announced that they would support a pharmacist refusing... which is why I don't do business with Target anymore. It seems to me that the outcome of one of the trials was that there had to be an alternate pharmacist on call who would fill prescriptions.

Googling along this line of thinking got this, part of the NYS pharmacy laws (in the Counseling section):
"Nothing in this subparagraph shall prevent a pharmacist or pharmacy intern from refusing to dispense a prescription if, in his or her professional judgment, potential adverse effects, interactions or other therapeutic complications could endanger the health of the patient."
posted by Houstonian at 3:54 PM on June 8, 2011 [1 favorite]


Oops, the link itself is here.
posted by Houstonian at 3:55 PM on June 8, 2011


For what it's worth, drugs that have a legal requirement for pregnancy tests or birth control measures prior to dispensing have very rigid programs, consent forms, protocols, and rules surrounding them. These include Accutane, Revlamid, Thalidomide and possibly some others that I am not aware of.

Doxyclycline is not one of them.
posted by SLC Mom at 7:38 PM on June 8, 2011


« Older Looking for a psychologist in ...   |  Are email Subject lines encryp... Newer »
This thread is closed to new comments.


Post