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January 28, 2025: Sarah and Kate dive into the Justice Department’s lawsuit against Walgreens critical failures in prescription monitoring and compliance within healthcare. In this episode, Sarah Richardson and Kate Gamble discuss the allegations, the role of healthcare IT in preventing misuse, and actionable steps for CIOs and CXOs to strengthen compliance protocols.

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Transcript

 This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today in Health IT, we are discussing Justice Department Suze Walgreens over alleged part in opioid crisis. My name is Sarah Richardson. I'm a former CIO for several healthcare systems, most notably with NHC and Optum and now president of the This Week Health 229 Executive Development Community, where we host a set of channels and events dedicated to transforming healthcare one connection at a time.

Today's episode is brought to you by Chrome OS. Imagine a healthcare system where technology works seamlessly in the background, keeping your data secure, your teams connected, and your patients at the center of care. Visit ThisWeekHealth. com slash Google Chrome OS to learn more. And I am joined by Kate Gamble, Managing Editor here at This Week Health.

Kate, welcome to the show. Thank you, Sarah. So the Justice Department is suing Walgreens over alleged part in opioid crisis. They're saying that the pharmacy chain dispensed millions of unlawful prescriptions, including opioids, without legitimate medical purposes. Some of the key points of this article, in addition to the unlawful prescriptions, they say though that was a violation of the Controlled Substances Act.

Walgreens allegedly pressured pharmacists to expedite prescription fulfillment, which led to the distribution of medications despite clear red flags. It also claims that there was a violation of federal laws. These actions breach the False Claims Act by seeking reimbursements from federal healthcare programs for prescriptions.

If found liable, Walgreens could face civil penalties up to 80, 850 per unlawful purchase. Prescription. And the impact on their stock value following this lawsuit's announcement, their stock experienced a significant decline, reflecting investor concerns over the allegations. Kate, what are we looking at here?

This is such a critical topic. But it's one that's difficult to approach because most, if not all of us, know at least one person who's been affected by the opioid epidemic. And we know it doesn't discriminate, whether it's age, race, socioeconomic status. But over the past few years, we've seen pharmaceutical companies and physicians being held accountable.

Now it's Walgreens, which is being accused, as you alluded to, of knowingly filing millions of invalid controlled substance prescriptions. So CIOs, of course, need to be aware of this. because this lawsuit underscores the critical importance of prescription monitoring systems and compliance protocols.

Ensuring that EHRs and pharmacy management systems have integrated safeguards can prevent the dispensing of illegal prescriptions. And this means collaborating across departments to strengthen data analytics capabilities and enable the identification of prescribing patterns that can indicate potential misuse or fraud, which we know some organizations have been doing a few years.

Sarah, as a former CIO, you could probably provide some perspective on what this entails, like from an IT standpoint?

Yes. And the reason I appreciate the perspective to provide is you go into overdrive mentally, you hear these things and you're like, okay, you're ticking through your systems.

You're ticking through your protocols in your own organizations. You're like, what are my technology safeguards? How are we handling regulatory compliance in this space? What are these pharmacist workflows look like? And how transparent are we with the data? So let's jump into that first one of when you consider technological safeguards in your organization, the real time monitoring.

Most organizations have the integration of real time prescription drug monitoring programs. We call them PDMPs. It's pharmacy and healthcare systems to flag any suspicious activity immediately. When you're Layering in the predictive analytics perspectives, you've got algorithms to identify prescribing patterns that can signal the misuse of fraud and look at frequent refills or high risk medications being prescribed together.

I recall programs we would put in place in the ER because we called them frequent flyers. That could apply to the fact that the person's been in the ED several times for a myriad of reasons. Often it was prescription drug or opioid related. And then if we take time to explore how these automation checks for DEA compliance during the prescription process can reduce human errors and prevent unlawful dispensing, you're already getting in front of some of the regulatory and compliance opportunities.

Right, and that's good information. And of course, we have to look at regulatory compliance and how IT tools can assist in regular internal audits ensure prescriptions align with federal and state laws. And then you need to think about cross state coordination, which so many of the health systems we know are across multiple states.

So you need to be able to bridge those gaps between the states. With differing regulations to ensure there's consistent compliance across regions. And in terms of training, need to consider how IT systems can integrate training tools for pharmacists and staff to stay updated on compliance requirements.

And we'll cover a story later this week specific to how virtualized training can actually be a huge differentiator and market advantage when it comes to these types of scenarios, because let's consider the pharmacist's workflow. How is the technology streamlining their workflow by reducing manual input, which allows them more time to focus on the clinical decision making aspects, and

IT systems can document and report instances.

of undue, let's just say corporate pressure to fill a prescription, empowering pharmacists to make ethical decisions. And we've been using decision support for years. How that clinical decision support tool or tools. and providing pharmacists with immediate evidence based, start over, and how decision support systems, which we have been using for years, can help clinicians with what they need to provide immediate evidence based insights to guide appropriate dispensing.

All of these pieces filter into when you consider your ancillary systems within the hospital pharmacy, lab, Radiology, these end up being, blood bank, these end up being the ones where you likely spend more of your time because of the nature of the work that is being done and the implications it has downstream.

And of course we have to touch on data transparency too. And we're seeing some potential for blockchain to create tamper proof records of prescriptions and ensure data integrity and trust between stakeholders. And then there's a need for seamless data exchange between pharmacies, healthcare providers, and law enforcement to identify patterns of misuse and ensure accountability.

Once again, interoperability is critical. And then in terms of public reporting, we can look at how anonymized data on. Opioid prescriptions could be used to inform public health strategies and policymaking, so the ability to use that data without necessarily implicating the person, the patient, I think is really important.

So really overall to me, this lawsuit is a pivotal reminder of the healthcare industry's responsibility to integrate ethical standards with technological solutions to safeguard patient health and uphold public trust. And that trust factor is something we've spoken about. And I don't think it can be overstated.

We're all patients and we all want to know that Health systems are doing everything they can to help prevent overprescribing of opioids and pain medications.

Three, it also goes back to those partnerships they had with these pharmacy benefit providers. And this is an alleged part in opioid crisis.

So Walgreens has the opportunity, obviously, to come back and talk about their best practices and protocols. And we'll be watching this story closely to see how it unfolds and what are the lessons learned, regardless of the outcome. There's going to be things here that are important for healthcare CXOs and partners to follow.

In order to make sure we don't fall into these patterns or the patterns that may raise red flags and concern, it's all about the ethical implementation of ensuring we're doing the right thing. So I'm glad we found this article. I'm also curious to see how this continues to play out and what it could mean in the longer term.

Absolutely. We'll keep an eye on this one. For sure. Remember to share this podcast with a friend or a colleague. Use it as a foundation for daily or weekly discussions on the topics that are relevant to you and the industry. They can subscribe wherever you listen to podcasts. Thanks for listening. That's all for now.

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