Accurate Education - My CVS Experience

The Politics of Pain

My CVS Experience

In September 2026 I was contacted by a CVS representative from their national headquarters. Referencing the Controlled Substance Act (CSA) governing the dispensing of opioids, in the words of the CVS representative, they had questions regarding my statistical “outlier” status. The representative went on to question me about what she described as “Red Flag” concerns, notably:

Based on statistics comparing me with other pain specialists, she identified:

More patients traveled more than 50 miles to seek my pain management
More of my patients received opioid prescriptions for more than 120 tablets per month, that she identified as “representing an increased risk for addiction and diversion”
CVS noted an increase in an undisclosed number of my prescriptions for oxycodone compared to previous undisclosed statistics
A undisclosed number of my patients were found to pay for their opioid prescriptions with cash, even in some cases when she claims they had insurance
Over the recent months, an undisclosed number of more patients have rotated to CVS from other pharmacies

The following documentation reviews the issues surrounding the application of inappropriate and illegal red flag policies that have had a tremendously destructive impact on the ability of pain patients to have their pain safely treated.

See:

Communications Sent to CVS in answer to their inquiries:

Some of the additional supportive documents sent to CVS

Additional pertinent documents:

CVS interrogations:

CVS Interrogation – Part 1 (9/23/26) (Transcript)
CVS Interrogation – Part 2 (9/24/26) (Transcript)
CVS – Why Banned & Requesting Appeal of Decision 10:20:26 (Transcript)

Key to Links:

Grey text – handout
Red text – another page on this website
Blue text – Journal publication

Definitions and Terms Related to Pain

My CVS Experience

Recently, like Walmart and Walgreens before them, CVS reached a settlement with the Department of Justice in which they were fined for their contribution to the opioid epidemic deaths a decade or more ago in which the DOJ found CVS responsible for knowingly filling opioid prescriptions to known pill mill physicians. They were also charged with Medicare and Medicaid fraud.

Large fines were imposed on these three pharmacy chains:

$50 million to Walmart
$350 million to Walgreens
$315 million to CVS.

As part of their settlements each of these chains were mandated to develop new policies for the dispensing of opioid prescriptions. These policies were developed based on algorithms based on statistical assessments of physician prescribing habits to identify those physicians whose prescribing habits fell out of range of the norm, referred to as “outliers”.

As with many pain management physicians, I am a statistical outlier based on the nature of my practice. Even compared with many other pain management physicians, I am an outlier. The obvious reason for this is that most pain physician’s practice structure is different than mine, in which many of their patients are episodic and seen for relatively short periods of time. They carry much fewer long-term opioid management patients. In fact, as you may have experienced, many of the “pain specialists” refuse to prescribe opioids and instead rely on short term pain management procedures, such as epidural steroids, and nerve blocks.

Historic Context

At the height of the opioid epidemic more than a decade ago, some people filled multiple illicitly-obtained opioid prescriptions at multiple pharmacies (“Doctor Shopping”). Based on these experiences, “Red Flag” behaviors were identified that raised suspicion of prescriptions being filled for non-medical purposes (diversion):

Patients seeking opioid prescriptions from doctors or pharmacies located more than 50 miles from the patient’s home
Patients filling opioid prescriptions in high quantities
Patients paying for opioid prescriptions with cash
Physicians predominantly prescribing fixed, high quantities (I.e. #180 pill counts), especially associated with trilogy prescription medications frequently abused and associated with increased risk of overdose deaths (opioids with benzodiazepines (i.e. Xanax) and Soma, a muscle relaxer).

Current Overreach of Prescriptive Authority by Pharmacists

It is now a not uncommon practice for pharmacists to solely rely on red flag concerns to refuse to dispense legitimate opioid prescriptions, with no efforts to confirm whether the red flag truly represents a safety concern. This practice has extended to the application of pharmacy chain policies (Walmart, Walgreens, CVS) that have resulted in bans of filling individual physicians opioid prescriptions based on red flag concerns, despite a lack of objective evidence that the physician is practicing illegally or outside the scope of their expertise or that their prescriptions are directed for diversion.

Based on a judgement by the United States Court of Appeals for the Fifth Circuit decision February 13, 2026 relative to the CSA, when a pharmacist confronts a situation in which they identify a “red flag,” the CSA directs that pharmacist to investigate their concern by communicating with the patient, the prescriber and/or other measures to identify “objective evidence” as to whether or not the red flag represents a counterfeit prescription or that the prescription is written for non-medical purposes (diversion). In the absence of such objective evidence, the judge dictated that the pharmacist must dispense the medication as prescribed by the clinician.

Furthermore, in this Fifth Circuit court decision, the Federal judge addresses red flag policies in no uncertain terms. To quote the judge, “Supreme Court’s decision in Gonzales v. Oregon, the Court explained that the CSA “regulates medical practice” only “insofar as it bars doctors from using their prescription-writing powers as means to engage in illicit drug dealing and trafficking. Beyond this,” the Court continued, “the statute manifests no intent to regulate the practice of medicine generally” (Italics mine).

The nuances of this decision-making lies at the core of the problems I present here and are the focus of what I believe to be inappropriate overreach of prescriptive authority by both individual pharmacists as well as corporate pharmacy chain bans on individual physicians.

Red Flag #1 50 Mile Principle

Recently, many pharmacists have been refusing to dispense medications to patients because either the patient lives more than 50 miles from the pharmacy, or the physician’s practice is more than 50 miles from the pharmacy. The concern relative to this red flag is based on experiences from more than a decade ago, when at the height of the opioid epidemic patients were traveling long distances to fill multiple prescriptions at multiple pharmacies (“Doctor Shopping”) in an effort to escape detection or gain the services of a physician practicing as a “pill mill.”

Of note, there is no rule, regulation, or law that applies a 50 mile limit to pharmacists dispensing a clinician’s medications. To the contrary, CDC guidelines specifically argue against engaging such red flags as policies.

Arguments for Overreach:

Lack of investigation by the pharmacist. In most cases, patients are given a brief explanation by the pharmacist that the DEA mandates the 50 mile policy and they could lose their license if they did not comply. I can provide testimonies from multiple patients who have experienced this problem in which the pharmacist performed absolutely no investigation as to the reason for the 50 mile circumstance. Patients are not questioned regarding their efforts to identify a closer pain management physician, nor are they questioned why the patient selectively chose their specific prescriber for their care, such as the prescriber offering services not available from closer pain management physicians. The patients were not questioned as to their history of pain/opioid management.

I have never been contacted by a pharmacist to discuss their concerns prior to my patient being turned away. The one exception to this statement is a local pharmacist in Kenner familiar with my practice who did discuss with me his perspective of the 50 mile concern. He told me that he personally was directed in person by DEA agents that he must turn away patients living more than 50 miles from his pharmacy. He was intimidated into the belief that if he failed to comply, his license would be threatened. He was not provided any written documents by the DEA, nor were any statutes referenced to support their directive. He expressed regret to me, but then proceeded to dismiss many patients from his pharmacy that had been going to him for years. This created significant hardships for many of these patients who were unable to find another pharmacy to provide their medications in a timely manner, causing the patients to experience significant increased pain, withdrawal symptoms and impaired quality of life. I can provide many signed affidavits attesting to the difficulties they experienced when they returned away.

This “Doctor Shopping” behavior has almost completely been eradicated since Louisiana and other states instigated the prescription monitoring program (PMP) in which all controlled substance prescriptions dispensed are monitored nationwide on a database accessible to all medical practitioners since 2008. It has been been mandated since 2017 that all physicians must monitor the PMP whenever prescribing a controlled substance. As such, the 50 mile principle essentially has little to no substance to it as an isolated means of identifying at-risk patients and should never be implemented as a measure of a physician’s practice safety.
The assumption of increased risk for substance abuse risk or diversion is not based on fact. There is no basis for this assumption, especially in a rural state, such as Louisiana with its extreme shortage of pain specialists. This is especially true when a practice such as Accurate Clinic offers unique services relative to pain management that are not offered anywhere else in the state of Louisiana.
If such a risk were to be identified, the pharmacist is obligated by law (CSA) to investigate the situation before summarily refusing to dispense the prescription. I can provide many testimonials from my patients in which they were simply denied service by a pharmacy because of the “50 mile Rule” with absolutely no effort made to confirm safety concerns such as asking the patient why they chose to come to my clinic or investigating my practice to determine if services I offer we’re not offered within a 50 mile radius of the patient’s home/pharmacy. In some cases, my personal efforts to intervene by supporting the patient’s circumstances regarding the 50 mile concern was rejected and the patient was terminated from their pharmacy anyway. This includes patients who had been filling their medications at the same pharmacy for many years.
CDC guidelines published in 2022 specifically identify this red flag concern as inappropriate. They explicitly denounce the creation of rigid, corporate, or algorithmic boundaries that interfere with individualized, patient-centered clinical care and that it should not be applied in the course of assessing pain management safety practices.
United States Court of Appeals for the Fifth Circuit in a recent decision (Neumann’s Pharmacy, L.L.C. v. DEA,) delivered in February 2026 again specifically identified the requirement that when a pharmacist identifies a”red flag,” the pharmacist must have actual knowledge based on objective evidence that a prescription was written for inappropriate purposes or otherwise was counterfeit prior to refusing to dispense a medication written by a physician in the usual course of their medical practice. This evidence is not being sought.

Red Flag #2. “High Pill Counts” of Immediate-Release Opioids

Of growing concern is the practice of pharmacists working in both large chains such as CVS and small “mom and pop” independent pharmacies, arbitrarily refusing to fill a prescription for what the pharmacist personally determined was an excessively high pill count – for example #180 immediate-release 10mg oxycodone tablets (a 60mg daily dose).

This red flag is based on the belief proposed by some pharmacists and promoted by the DEA, that chronic pain patients filling such high pill counts are selling some and taking the rest. It is interesting to note that these same pharmacists offer no resistance for filling a prescription for #120 oxycodone-30 mg tablets (a 120mg daily dose) which represents double the opioid potency and potentially double the risk for contributing to overdose deaths, abuse and diversion.

Arguments for Overreach:

Lack of investigation by the pharmacist. I can provide testimonies from multiple patients who have experienced this problem in which the pharmacist performed no investigation as to the reason for the high pill counts.The patients were not questioned as to the nature of their pain condition nor their history of pain/opioid management (other than, “Why do you need so many pain pills? ” – often voiced in a demeaning and accusatory manner). I have never been contacted by a pharmacist to discuss their concerns prior to the patient being denied filling their full pill count as designated on my prescription. Worst of all, recently when my Staff did reach out to a CVS pharmacist, they were rudely dismissed and screamed at with no effort to investigate their concerns. Narratives of this specific experience can be provided by both the patient and my staff upon request.
The fact is an immediate-release opioid prescribed #180 tablets per month is based on directions that the patient take one tablet every four hours as needed for their pain. Every four hours is pharmacologically appropriate and preferred in many cases over other alternatives for efficacy and safety reasons as well as for financial reasons. Furthermore, the decision regarding pill counts and directions is under the prescriber’s purview who knows the patient and should not be changed without definitive objective reasons for doing so based on conversations with both the patient and the prescriber. This has never been the case.
The assumption of increased risk for substance abuse risk or diversion is not based on fact. Research has demonstrated that this assumption is simply not true. Even the DEA’s own statistics demonstrate that a very small percentage (less than 5%) of legitimate opioid prescriptions are diverted. Furthermore, it has been established that the majority of prescribed opioids that do get diverted mostly come from family members sharing their medications and most of these were derived from prescriptions written by surgeons and primary care physicians for short courses of acute pain management that were not fully used – NOT sourced from chronic pain patients treated by pain specialists.
CDC guidelines published in 2022 specifically identify this”high pill count” red flag concern as inappropriate and that it should not, in isolation, be applied in the course of assessing pain management safety practices.
United States Court of Appeals for the Fifth Circuit, as noted above in the “50 mile flag” section of this narrative, in a judgment delivered in February 2026 again specifically identified the requirement that when a pharmacist identifies a”red flag,” the pharmacist must identify objective evidence that a prescription was written for inappropriate purposes or was counterfeit prior to legally refusing to dispense a medication written by a physician in the usual course of their medical practice. This evidence is not being sought.

Red Flag #3 Inappropriate “Blackballing” Physicians Identified as”Outliers” Including Those Based on Red Flag Concerns

Arguments for Overreach:

The practice of “Blackballing” pain management physicians who are determined to be statistical outliers appears to be a growing practice by pharmacy chains. Several years ago, Walmart Pharmacies began this practice of blackballing many pain management physicians as a consequence of a settlement with the Department of Justice when they were found guilty of contributing to the opioid epidemic deaths. In their effort to re-organize policies regarding the dispensing of opioids, they applied “outliers” as a basis for their decision-making to blackball a physician. Again, this is contrary to CDC guidelines and it is illegal because it specifically counters the CSA as noted above..

I do not have statistical or other details to present to you at this time, but I wish to bring the situation to your attention because Walgreen’s followed Walmart example two years ago, again as a consequence of a settlement with the Department of Justice, and they did the same thing. In both of these cases, I was targeted as an outlier, and banned by these two chains from having my controlled substances prescriptions filled. I believe it is important to also point out that neither Walmart nor Walgreen’s reached out to me personally to discuss their decision, and like many other pain specialists, I was offered no recourse to repeal their decision.

The consequences of this decision had significant impact on opioid access by patients who frequented these pharmacies. Furthermore, it shed an inappropriate negative impact on the reputations of many reputable pain specialists.

The Walgreen’s event caused quite an uproar in the pain management community throughout the country as it was a ban applied nationwide. I myself was blackballed specifically because I was an outlier despite the fact that my pain practice was exemplary and I was not notified of any complaints, nor did I have any lawsuits or regulatory investigations or any other reasons for being blackballed.

The consequences of this action by these pharmacy chains inappropriately demeaned my professional reputation but I was provided no recourse or venue for appeal. Because I was blackballed by Walgreen’s I was informally contacted by the Louisiana State Board of Medical Examiners who determined that there were no safety concerns or indications for an investigation regarding my pain management practice.

Chain Pharmacies – My CVS Experience

In September I was contacted by a CVS representative from their national headquarters. Referencing the CSA governing the dispensing of opioids, in the words of the CVS representative, they had questions regarding my statistical “outlier” status.

She asked about 4 concerns:

1. I write prescriptions for more patients who live outside of a 50 mile distance from the clinic then average pain doctors. (Likely accurate for many reasons, mostly due to lack of pain specialists within 50 miles of my patient’s residence in rural communities, and the fact that my practice is unique and offers services not provided by other practitioners). In addition to these arguments coupled with the legal argument described above, I provided CVS with 151 signed affidavit testimonials from my pain patients surveyed about why they chose to come to Accurate Clinic that demonstrated appropriate reasons for coming to my clinic. It is clear that CVS ignored the evidence, including the testimonials presented to them, which in effect is simply demonstrates they chose to disregard the truth, blindly taking inappropriate action solely based on a “red flag”.

Furthermore, I provided extensive evidence demonstrating the many non-opioid treatment options offered at my clinic that are not offered by other pain management specialist and represent reasons why people may drive the extra mile to seek their treatment Accurate Clinic

2. I write more prescriptions for short-acting opioids such as Norco, Percocet and oxycodone in which the pill counts exceed #120/month. The. CVS representative asked me “don’t you know that prescribing #180 short-acting tablets increases risk for addiction and diversion?” (Not accurate) There are many arguments, including financial, safety and effectiveness, for the advantage of prescribing higher frequency, lower potency, short-acting opioids rather than lower frequency higher potency opioids. This is not a metric for assessing the safety of a prescribers practice, especially given that this is a decision that must be made by the prescribing physician who is knowledgeable of the patient’s medical condition, not a pharmacist looking at a paper with a number on it. Furthermore, CDC guidelines argue specifically against using a metric of pill counts for assessing practice safety.

3. “An unusual number of my patients purchase their prescriptions using cash, sometimes even when they have insurance.” They wanted to know why. (I can only speculate — no insurance? high co-pays? — but the vast majority of pain management physicians do not accept patients without insurance as I do, so it is likely I would be an outlier based on comparison with other pain specialists).

The law does not require that I scrutinize how my patients pay for their medications. I am required by law to review the Prescription Monitoring Program (PMP) to confirm that patients are not doctor shopping, which is the concern raised by patients paying for their prescriptions with cash. All of my patients have their PMP profiles reviewed every month which is all the law requires that I do to meet the standard of care. The same law also requires that the pharmacist review the PMP prior to dispensing so they have their own mechanism of confirming whether “cash pay” represents a doctor shopping concern.

4. Finally, their last concern voiced to me was that over the recent months they have noticed more of my patients coming to CVS to have their prescriptions filled then usual. The reason is that many independent pharmacies have been unable to obtain adequate supplies to meet patient needs and/or they were turned away from independent pharmacies based on 50 mile policies. These patients were therefore referred to CVS pharmacies within a 50 mile radius, who also were more likely to have adequate supplies of necessary medications.

Because of my experience with Walgreen’s, I took their inquiry with grave seriousness. They specifically threatened me, telling me that the outcome of this inquiry would determine whether they would continue dispensing my prescriptions nationwide. Although not offered to me, I did request if I could send supportive documents to provide greater detailed responses to their inquiry, which they allowed. I asked whether if they came to a decision to ban me, would I have the opportunity to appeal or discuss it further with a representative of CVS. I was told “No, not until a full 12 months had passed.”

Consequently, I provided extensive, detailed documentation arguing against the interpretation of their safety concerns based on the four circumstances they provided, far beyond the brief comments I have made here. I believe my arguments are watertight and leave no room whatsoever to legitimize banning the dispensing of my prescriptions out of “safety concerns.” In fact, I offered evidence that I believe firmly establishes me as the safest opioid prescriber in the state.

Nevertheless, I received a letter dated October 20, 2026 from CVS declaring that I was banned from having my controlled substance prescriptions dispensed as of October 22. Adding injury to insult, this provided my patients with no advance notice to find an alternate pharmacy who could fill their medications, something especially difficult at this time based on the reasons provided above. The immediate impact on my patients learning of this ban has been very disturbing, contributing to a great deal of anxiety, fear, and resentment of being inappropriately targeted and demeaned.

Honestly, this has become a checkbox witch hunt and it is very concerning for its impact on my patients ability to get their prescriptions filled, for their safety and for their quality of life as well as the impact it will have on my reputation and my practice.

To provide transparency regarding my CVS experience, I have created a webpage, www.accurateclinic.com/mycvs experience

On this webpage, I have copied this document and provided links to additional documents, providing background and more in-depth information to the problems. Paying patients must confront to have their pain appropriately managed.

I have included links to the letters I provided in my response to the CVS inquiries

I have also uploaded the recordings of my interactions with the CVS representatives in their initial inquiry, as well as my follow-up call to CVS upon receiving the letter banning me. I have also uploaded transcriptions of the conversations that clearly document their inappropriate process.

I have also attached the full decision of the United States Court of Appeals for the Fifth Circuit decision in February 2026.

I would like to stress that the focus of my efforts to illuminate the reader here is not to focus on recovering my relations with CVS. Rather, I present the CVS details here as representative of the overreach that I believe pharmacies and pharmacists are engaging.

Summary

The circumstances I have described above have led to significant difficulties for my chronic pain patients to manage their pain safely and effectively. The repercussions of these difficulties have led to significant compromise to patient safety, quality of life and activities of daily living. Furthermore, although this narrative focuses on the experience of patients in Louisiana, it is quite likely that similar problems occur nationwide, especially in states with large rural populations.

It has been well established that when pain patients are unable to access appropriate and safe pain management from the medical community, they will seek illicit pain medications out of desperation. It is also clear that when they do so, they engage a high risk of accidental overdose, contributing to the opioid death “epidemic.” It has been reported that 60% of the opioid-related deaths associated with illicit opioids have occurred in patients seeking relief for their pain — it is not limited to patients with opioid addiction.

It is my contention that unless we correct the problems I identify here, the result will be the fueling of further opioid-related deaths rather than limiting them. This contention is well supported by facts.

Additionally, the fear of regulatory action has had a serious chilling effect on the management of pain by the medical community. This is reflected in a broad reduction of adequate pain management being provided or even offered by primary care physicians as well as pain specialists. It has been reported that applicants for specialty training in pain management have suffered significant reduced numbers over the last couple of years which will further contribute to difficulties for patients to have their chronic pain managed safely and appropriately.

While I do agree with the need for an alliance between the pharmacist and the prescribing physician, I believe that the ability for physicians and pharmacists to work together as a team has been compromised and in some circumstances, has even become adversarial. Unfortunately, both independent and chain pharmacy’ policies, including Blackballing, and individual pharmacist behaviors demonstrate excessive overreach that is not supported by either the law (specifically the CSA), by pain management guidelines, or by science — and it is definitely NOT supported by common sense.

I look forward to hearing from anyone with insights as to how we may proceed to improve the situation. I thank you in advance for any help or advice you may provide to facilitate addressing these problems.

Emphasis on Education

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