Last Christmas Eve, Dan Quartin of Newington brought his 11-year-old cat to the veterinarian.
"They determined that the cat, Rusty, had diabetes," Quartin said. "The doctor printed out on a computer what I needed to get at a pharmacy — the insulin and the syringes."
He called his usual pharmacy in Newington, but being Christmas Eve, it had closed early. He went to the CVS on New Britain Avenue in West Hartford. He approached the two pharmacists behind the counter about getting the insulin and five syringes.
"I told them the vet gave me this information," he said. "The girl looked at me and said, 'These are directions, they're not prescriptions."
Quartin said he was pretty sure he didn't need a prescription for insulin, but thought that maybe the law had changed. So he went home and looked it up on the Internet — he didn't need a prescription.
"I printed out this information from the Internet and went back to CVS on Christmas morning," he said. "They told me 'Well, you don't need a prescription, but it's up to the discretion of the pharmacist.' So I found a Rite Aid at East Hartford and they said 'Sure, come on down.'"
By that time, he said, "we went almost 24 hours without the insulin that the cat needed."
Danielle Marcus, a CVS spokeswoman, sent this statement regarding the incident:
"Under the law, pharmacists are permitted to use their professional discretion in deciding whether to sell syringes without a prescription. Regarding the incident in question, the customer did not provide our pharmacy with any medical documentation."
Quartin insists he did bring documentation. It wasn't a prescription, he said, but detailed directions from his veterinarian.
"I could understand if I looked like a junkie and they were worried about what I was going to do with the syringes," he said.
Quartin administered the insulin Christmas Day, but Rusty died less than a week after Quartin brought him to the vet.
"I don't know if the insulin was administered [sooner] whether that would have made a difference," he said. But it's possible that it could have, he said. "What if it was a human?"
While Quartin is right that insulin and syringes (up to 10 of them) don't require a prescription, the CVS employees were correct that they aren't required to sell either to a customer.
"Pharmacists can always use their discretion," said Margherita Giuliano, executive vice president for the Connecticut Pharmacists Association. The law doesn't mandate a pharmacist to do anything they're not comfortable with, she said.
There are more types of insulin now than ever, she said, so there might be some concerns among pharmacists that the customer isn't seeking the right one or doesn't have the proper dosage. Giuliano stressed that she doesn't know the details of Quartin's situation and wouldn't speculate as to why the CVS pharmacists refused to sell to him.
Even with a prescription, a pharmacist can choose not fill the order, said John Gadea, director of drug control for the state Department of Consumer Protection.
"If a person comes in obviously impaired, you're not going to fill that script, and you're well within your right not to," he said.
Gadea said pharmacists are more proactive than they used to be when it comes to filling prescriptions. "Decades ago," he said. "physicians would write a script and pharmacists would fill it" with no questions asked.
But eventually the U.S. Drug Enforcement Agency began questioning pharmacists when prescriptions proved to have the wrong dose or even medications.
"Now the majority will use their professional judgment and their six years of education, a lot of which was clinical based," he said.
Dr. Mohan Sachdev, president of the Connecticut Veterinary Medical Association, said he always writes out a prescription — or calls the pharmacy in advance — when a client's pet needs insulin. That avoids the kinds of problems that Quartin faced.
Mohan said the only problem that he can think of that his clients have had with prescriptions is occasionally finding the drug. For instance, Heartgard — used to treat heartworms — is sometimes hard to find. But he said that Wal-Mart usually has it in supply.
Some drugs are even tougher. A couple months ago, he said a dog with arrhythmia was brought to his practice, the New England Veterinary Emergency Center and Cancer Care in Windsor. They needed to treat the dog with a drug called diltiazem. After a frantic search, they were able to track it down at St. Vincent's Medical Center in Bridgeport.
"Without it there's no way the dog would have lived," said medical director Scott Shaw. He said "every couple of months" there's a struggle to find the right medications. If a supplier is running short on a certain drug, he said, they're going to bring it to the human hospitals before they supply veterinarians.
Why You Might WantA Prescription Anyway
Gadea added that, in many cases, it's a good idea for human patients to ask for a insulin prescription so they can get reimbursed by their insurance companies. As in most states, insurance companies in Connecticut are required to cover the costs of prescribed insulin for diabetes patients.
Gadea also points out that, although most forms of insulin do not require a prescription, a few do. These are mostly ones that have been on the market for the last few years.