Walmart operates a lot of pharmacies, especially in rural areas. Many of those areas were hit hard by the opioid crisis, which killed around 450,000 people between 1999 and 2018. Now, the U.S. Department of Justice, along with a number of states and municipalities, is suing Walmart over its willingness to sell billions of extremely addictive pain pills without sufficient safeguards.
NPR interviewed at least one pharmacist who worked at Walmart during that period. He claims that “red flags” kept popping up that should have required the retail giant to step in and stop filling so many questionable prescriptions.
Instead, he says, his warnings to the company were met with explicit threats and retaliation. He was fired in 2013 after raising the issue with local police and the Drug Enforcement Administration. He has filed a whistleblower protection lawsuit which is still pending.
Pharmacists are supposed to raise the alarm on questionable prescriptions
The federal Controlled Substances Act puts pharmacists in the position of gatekeepers. Doctors are supposed to prescribe medications only for legitimate purposes, but some fail in their duty. When they do, pharmacists are supposed to raise the alarm and refuse to process the prescriptions.
Pharmacists across the country warned Walmart executives about red flags on opioid prescriptions, the Justice Department’s lawsuit reveals. Some of those red flags included:
Patients driving long distances to purchase pills
- Patients paying in cash
- Patients who couldn’t explain why they needed powerful opioids
- Prescriptions that weren’t filled out properly
- Physician signatures that seemed to have been printed by computers
- Pharmacists being unable to reach prescribing physicians with questions
Walmart has responded to the lawsuit by claiming that the pharmacists themselves should have refused to fill any questionable opioid prescriptions. It insists that its policies were responsible and lawful.
The pharmacist interviewed by NPR did refuse to fill suspicious prescriptions. But he and many other Walmart pharmacists say that the retailer pressured them to keep quiet.
“They told me, ‘Do not reach out to the DEA, do not call the police. If you do so, your employment is going to be terminated immediately,'” he told NPR.
The lawsuit reveals that pharmacists told Walmart executives that “pill mill” doctors were sending their patients to Walmart pharmacies because other chains had started refusing to fill the prescriptions. The pharmacists told Walmart that they were afraid they would lose their jobs and licenses if they continued to fill the suspicious prescriptions.
According to the U.S. Attorney for the Eastern District of North Carolina, who is involved in the lawsuit, Walmart ignored the red flags and the warnings from its own pharmacists.
“For years, Walmart did nothing except continue to dispense thousands of opioid pills,” he said.
Indeed, according to a pharmacy professor, chain pharmacy employees often lack the information, time, training and corporate backing to refuse questionable prescriptions. Bonuses are typically linked to efficiency and sales, not safety goals. In a nationwide survey of pharmacists, those working at Walmart and other chains were more likely to say they feared disciplinary action if they questioned too many prescriptions.
Walmart denies any wrongdoing
A Walmart spokesperson declined to comment to NPR. However, in October the retail giant filed suit against the Department of Justice and the Drug Enforcement Agency, claiming that the government agencies are seeking to shift blame to Walmart.
That blame, Walmart claims, properly lies with problem doctors and the government regulators whose job it was to police them. It claims that federal investigators unethically schemed to “embarrass” Walmart and leverage a large settlement.
In 2011, Walmart signed an agreement with the DEA promising to institute reforms. Yet by 2016, when the DEA raided a Walmart pharmacy for unlawful prescription practices, no such reforms were in evidence.
Other chain pharmacies including Rite Aid, Walgreens and CVS, are also facing lawsuits over their opioid prescription practices.