Recent concerns about opioid misuse and abuse have led payors, policymakers and retail pharmacies to attempt to restrict the dispensing of prescribed opioid dosage and duration. One such policy of great concern is Walmart’s corporate policy that limits opioid prescriptions to seven days or 50 morphine milligram equivalents, which is causing harm to patients with acute, palliative, cancer-related, chronic pain and other medical conditions requiring amounts or doses greater than the policy allows. Walmart is inappropriately interpreting the Center for Disease Control (CDC) guidelines for prescribing opioids to set these policies. Such arbitrary prescribing thresholds interfere with the patient-physician relationship, physician practice and patients’ access to quality care and treatment.

In some case, physicians have been inexplicably “blacklisted” where Walmart refuses to fill their prescriptions for controlled substances without explanation, and the physicians are left without a means of contesting the decision.

As part of continued efforts to resolve the issue with Walmart, the American Medical Association (AMA) sent a letter to Thomas Van Gilder, M.D., Chief Medical and Analytics Officer for Walmart, Inc. on September 24, 2019, regarding its corporate prescription opioid restriction policy, also referred to as its “refusal to fill” policy.

On multiple occasions, AMA has requested that Walmart be transparent by explaining the algorithm it uses to justify restrictions to prescriptions, but according to AMA, all of its  letters have gone “without a meaningful response.”

 “Your ‘refusal to fill‘ policy also has disrupted legitimate medical practices that receive form letters telling them their prescribing rights under state law will be superseded by a Walmart-created algorithm that deems a physician unfit to prescribe,” James Madara, M.D., CEO and Executive Vice President of AMA wrote in the letter to Walmart. “We are not aware of any state law or regulation that gives a corporate entity the authority to take action against a licensed health care professional. If a state legislature has enacted an opioid prescribing restriction or other law, then the health care professionals in that state are required to follow the law as a matter of professional licensure. We are not aware of any medical or pharmacy board abrogating its licensing oversight in favor of a national corporate entity using an unknown algorithm, and we therefore urge you to rescind your policy. Simply put, this policy is interfering in the practice of medicine and pharmacy.”