By KRISTIN L COLETTI-GIESLER, MSN, APRN, FNP-C, FAAMFM, ABAAHP
Access to specialized healthcare is already limited in many parts of Alaska, and patients face additional barriers when pharmacists obstruct medically necessary care. This challenge is even more significant for patients seeking uniquely specialized alternative treatments, such as in anti-aging, functional, and metabolic medicine, and particularly in the rare specialty of environmentally acquired illnesses.
Unfortunately, the misuse of authority by pharmacists to delay or deny prescriptions is a troubling trend that demands immediate attention.
Recently, I encountered a situation in which a pharmacist refused to fill a prescription for a child suffering from Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANDAS is a devastating neuroimmune condition that can be triggered by a streptococcal infection, such as strep throat or scarlet fever (Swedo et al., 1998).
This condition causes the sudden onset of obsessive-compulsive disorder, tic disorders, or both, and requires timely treatment to prevent severe complications such as cognitive decline, debilitating tics, and even self-harm (Murphy et al., 2015). It is also often accompanied by other environmentally acquired illnesses, making timely treatment a necessity.
As Dr. Jill Crista writes in her book “A Light in the Dark,’ the longer we delay treating inflammation in the brain, the harder it becomes to reverse.
“Timing is everything when it comes to treating PANS and PANDAS,” Crista wrote. Unfortunately, instead of fulfilling the professional obligation to dispense the medication promptly, the pharmacist delayed care by berating the provider, questioning the diagnosis, and asking whether the child had sought a second opinion.
Ironically, I was actually their third opinion, and they found me through researching the experts in environmentally acquired illnesses, my mentors Dr. Neil Nathan and Dr. Jill Crista, who have contributed significantly to understanding the interplay of PANDAS, PANS and environmental factors.
This is not an isolated incident. Patients across the state have experienced similar delays and denials, especially during the Covid-19 pandemic, when pharmacists refused to fill prescriptions for critical, evidence-based treatments for serious conditions. Alaska’s former Board of Pharmacy chair allowed such abuses to persist unchecked. Under his leadership, countless Alaskans were denied access to alternative treatments, leaving them to suffer unnecessarily. This behavior not only delayed care but also eroded public trust in the pharmacy profession.
The Pharmacist’s Role and Responsibility
While pharmacists play a critical role in the healthcare system, their scope of practice does not include second-guessing the medical decisions of licensed healthcare providers. When pharmacists interfere by questioning valid prescriptions or demanding to see clinical protocols, they overstep their boundaries and put lives at risk. Their role is to ensure that prescriptions are dispensed safely and appropriately—not to obstruct care due to a lack of understanding about complex medical conditions (American Pharmacists Association, 2021).
As Dr. Neil Nathan states in “Healing Is Possible,” “Patients with complex illnesses are often hanging on by a thread. Any delay in treatment, especially for those suffering from neuroinflammation, can cause the thread to snap, leading to further deterioration and prolonged suffering.”
The Right to Alternative Care
Every patient has the right to seek alternative and integrative care, especially when conventional approaches fail to address their needs. As a provider specializing in environmentally acquired illnesses, chronic infections, and neuro-immune conditions like PANS and PANDAS, I work with some of the sickest patients in Alaska. These patients often require timely and innovative interventions to reverse their illnesses and improve their quality of life.
When pharmacists abuse their power by refusing to fill prescriptions, they are not just delaying care—they are actively jeopardizing patients’ right to choose their own path to wellness.
A Call to Action
The people of Alaska deserve better. It is time to hold pharmacists and the institutions that employ them accountable. Patients should not have to fight for their basic right to access the medications prescribed by their trusted healthcare providers.
To achieve this, we must:
- Demand accountability: Pharmacists who delay or deny care without valid legal or medicaljustification must face consequences, including reprimand or termination.
- Educate pharmacists: Require additional training for pharmacists to ensure they are well- informed about complex medical conditions and their treatments. Contrary to common misconceptions, our approach is thoroughly evidence-based, supported by extensive research. Numerous resources, including a wealth of studies, are available through organizations such as the International Society for Environmentally Acquired Illness, the International Lyme and Associated Diseases Society, and the American Academy of Environmental Medicine.
For example, last year, a local pharmacist refused to fill medications for a patient with Chronic Inflammatory Response Syndrome and Babesia, a tick-borne disease. The provider brought this pharmacist a copy-paper-sized box of over 1,000 studies. The pharmacist never questioned that provider again. However, this was a daunting, time-consuming task, and as providers, we simply do not have time to do this for every uninformed pharmacist.
- Advocate for patients’ rights: The public must be made aware of their right to seek alternative care and report any interference by pharmacists to regulatory authorities.
As Dr. Crista states, “The brain doesn’t wait. Ignoring or delaying care for neuroinflammatory conditions only causes deeper harm and greater suffering in the long term.”
I also want to acknowledge the many amazing pharmacists I work with who genuinely care about their patients. When they have concerns or need clarification, they reach out with professionalism and respect, seeking to collaborate rather than obstruct care. Their dedication to supporting providers and patients alike is invaluable, and I am deeply grateful for their efforts. It is my hope that all pharmacists will aspire to this standard, fostering a culture of collaboration that ensures patients receive the timely and compassionate care they deserve.
The pharmacy profession is built on trust and collaboration between healthcare providers, pharmacists, and patients. When that trust is broken, it is the patients—often the most vulnerable— who bear the consequences. These abuses of power are not just professional failures; they are ethical breaches that jeopardize lives. It is imperative that we hold pharmacists accountable and demand systemic changes to ensure that Alaskans can access the care they need without unnecessary barriers or delays. The time to act is now—patients cannot afford to wait.
Kristen L. Coletti-Giesler is licensed with the following degrees: MSN, APRN, FNP-C, FAAMFM, ABAAHP. She is a family nurse practitioner at Be-Well Medicine on the Kenai Peninsula, an adjunct nursing instructor; and an advanced fellowship diplomat in anti-aging, metabolic, and functional medicine.
References
- Brimberg, L., Benhar, I., Mascaro-Blanco, A., et al. (2012). Antibody-mediated behavioraland neurochemical changes in the basal ganglia: A possible mechanistic model for neuropsychiatric symptoms in PANDAS. The Journal of Neuroscience, 32(5), 10229– 10242. https://doi.org/10.1523/JNEUROSCI.0535-12.2012
- Chang, K., Frankovich, J., & Cooperstock, M. (2015). Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology, 25(1), 3–
13. https://doi.org/10.1089/cap.2014.0084 - Crista, J. (2022). A light in the dark: Understanding PANDAS and PANS. Two Ponds Press.
- Murphy, T. K., Gerardi, D. M., & Leckman, J. F. (2015). PANDAS: Reaction to infection or to the treatment? The American Journal of Psychiatry, 171(4), 356–
359. https://doi.org/10.1176/appi.ajp.2013.13091201 - Nathan, N. (2018). Toxic: Heal your body from mold toxicity, Lyme disease, multiple chemical sensitivities, and chronic environmental illnesses. Victory Belt Publishing.
- Nathan, N. (2024). The sensitive patient’s guide to healing: Top experts offer new insights and treatments for environmental toxins, Lyme disease, and EMFs. Rogue Health Press.
- Swedo, S. E., Leonard, H. L., Garvey, M., et al. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): Clinical description of the first 50 cases. American Journal of Psychiatry, 155(2), 264–
271. https://doi.org/10.1176/ajp.155.2.264
During the COVID madness, I experienced pharmacists refusing to fill a prescription at both Fred Meyer and Safeway. Shook the dust off my feet and left their sorry souls behind. Forever. Fortunately was able to find a way around them, but was certainly confounded with their behavior. Their actions were clearly not right.
Glad to see word of their inappropriate behavior(s) reverberate.
Never had a problem at Costco!
Me Too! Hoping for a Class Action lawsuit against them to prove to them that their job is to DISPENSE PRESCRITONS and not to play Doctor.
‘https://www.goodreads.com/book/show/217062667-moving-beyond-the-covid-19-lies
In 2025, there is a push to convert every profession into a chokepoint for anything deemed not sufficiently “woke”, your banker, your doctor and your pharmacist are no exception. Alaska’s small population makes this a huge issue. If the pharmacist in your community is committed to enforcing woke dogma you could be in real trouble.
When pharmacists began refusing to fill prescriptions for ivermectin many Alaskans had to go outside to have their prescriptions filled. Unfortunately, we have a very unsympathetic legislature, which then moved legislation to increase penalties on outside pharmacies serving Alaskan residents.
My uncle was unable to get the medication he needed during the pandemic. He didn’t make it.
We put forward two bills to move forward the conversation on pharmacists serving as political gatekeepers.
Your electric company does not have the right to deny you electricity because it doesn’t like what you are going to do with it. Your pharmacist shouldn’t have that right either, excepting when a drug is being used to deliberately kill someone.
One approach is for the legislature to make certain drugs (like ivermectin) available by standing order:
‘https://www.akleg.gov/basis/Bill/Detail/32?Root=HB%20388
Another approach would be to treat pharmacists akin to a public utility like an electric company.
‘https://www.akleg.gov/basis/Bill/Detail/32?Root=HB%20388
I’m not saying either are the best solution, but when government has created a situation where I have to go to a pharmacist to obtain a lifesaving drug it is unacceptable for that pharmacist to then determine my fate simply according to whatever their personal politics happen to be at the time.
Thank you for your response. I will share it.
I don’t see any medical certifications in your bio much less a doctorate of any kind. Why do you believe you have the education or experience to dispute the education and experience of a pharmacist?
Ah, once again we see the ignorant and gullible (not to mention morally and intellectually bankrupt) “trust the experts” talking point, the latest version of the logical fallacy known as “the appeal to authority”.
Svidri, why do YOU automatically believe that “the experts” do not ever have a political and power agenda of their own? Because more often than not they do, you know.
You have all the naivete and gullibility of a four year-old child. It scares me, however, that you are most likely an adult, and are sharing the same society with me.
The stubborn ones should lose their license. Period. This is totally unacceptable. I agree witht the author that the vast majority are great and simply want the patient to fully understand what they are taking and how to best use it. The rogue ones need to go.
Wow! This same thing has happened with my Nurse Practitioner, who both my husband see and love. As someone over 65 it is very difficult to find someone in AK to take Medicare, so many of us have begun seeing NPs. What we love about her is that, along with western medicine, she looks for alternate ways to treat us. If the person is licensed in the state it is NOT the pharmacists business. If she has a complaint against the doctor then she needs to file a complaint with the state. Many of the foods we eat and the medicines we ingest are what is really harmful.
At the start of covid, I was diagnosed with chronic Lyme disease. I had to be on a four month course of atovaquone-proguanil and ivermectin. The Wasilla Fred Meyer refused to fill the prescription, and my doctor had to prove my diagnosis to them before they would fill it!
Ms. Kristen L. Coletti-Giesler, Thank you for an eye-opening article. I have never understood how a pharmacist can negate/countermand a doctor/nurse’s orders. If pharmacists continue to do this, then I suggest it be mandated that they sign a form letter holding them accountable and responsible for the person’s health outcomes as a result of withholding the prescription. As David Eastman says above, there seems to be an effort to add “choke points” in healthcare.
Great article!
You don’t understand because you’re uninformed. Pharmacists have a legal obligation to question a doctor or nurses orders when they need additional information. A quick google search can educate you.
Coming next: grocery store cashiers who refuse to ring up your grocery items unless they personally approve of them.
“Do you REALLY need those Little Debbies? I don’t think so!”
It would appear that the author of this article, despite her certifications, none of which are doctorates, misunderstands the role and responsibilities of pharmacists. Rep. Eastman also seems to lack knowledge in the medical field. Please read this from the Alaska Board of Pharmacy:
FREQUENTLY ASKED QUESTIONS ABOUT CONTROLLED
SUBSTANCE PRESCRIPTIONS
Can a pharmacist ask a patient or prescriber about my medical condition and treatments?
Yes. Pharmacists are trained, allowed, and OBLIGATED to ask both patients and PRESCRIBERS questions about any prescription.
This may include any inquiry about previous medications or other attempts to treat the condition for which the prescription is
being presented. This is not a violation of the Health Insurance Portability and Accountability Act (HIPAA).
What law authorizes a pharmacist to ask questions regarding my control substance prescription?
Title 21 of Code of Federal Regulations, Section 1306.04(a) OBLIGATES a pharmacist to make sure that all controlled substance
prescriptions are being dispensed “in the usual course of medical treatment.” Therefore, a pharmacist may need to gather
further information by communicating with the patient’s prescriber.
What if I or my prescriber do not want to answer questions from the pharmacist?
If a pharmacist cannot obtain adequate information from either the patient or prescriber’s office to answer their questions or
address their concerns, then they are obligated to refuse to fill the prescription.
What resources may a pharmacist use to evaluate whether a prescription meets the “usual course of medical treatment?”
• the prescriber’s office to gather more information about the condition and treatment
• the Prescription Drug Monitoring Program or other software that helps analyze dangerous combinations and dosages
• board of pharmacy statutes and regulations, and published medical literature
• the medication package insert
• published information / guidelines from the Drug Enforcement Administration (DEA), Food and Drug Administration
(FDA) or Centers for Disease Control (CDC)
What other criteria does a pharmacist evaluate for a controlled substance prescription?
• other aspects of a control substance prescription that a pharmacist may evaluate prior to dispensing may include
multiple individuals presenting prescriptions for the same drugs in the same quantities from the same doctor
• individuals presenting prescriptions for controlled substances known to be highly abused
• individuals paying high prices for controlled substances (a DEA “red flag”)
• individuals residing long distances from the pharmacy or passing multiple pharmacies to get a prescription filled. These
are known as possible “red flags” by the DEA and require that pharmacists evaluate prior to dispensing the prescription.
• This is not an all-inclusive list and is meant to provide examples of what pharmacists may evaluate. You can find more
information about this at: ‘https://www.deadiversion.usdoj.gov/mtgs/pharm_awareness/conf_2013/march_2013/carter.pdf
May a pharmacy request my identification for a controlled substance prescription?
Yes. The DEA provides pharmacists with guidelines to confirm a patient’s identity before filling a legitimate prescription.
Can a pharmacist refuse to fill my prescription?
Yes. If a pharmacist receives a prescription that does not meet the federal regulation above, they are allowed and obligated
to refuse the prescription. In addition, if a pharmacist believes that any prescription is written for a medication, strength,
direction, or combination that is not safe, then the pharmacist is obligated to refuse to fill the prescription. The Alaska Board
of Pharmacy encourages pharmacists to work with the prescribing practitioner to resolve concerns prior to refusing to fill.
What happens after a pharmacist refuses to fill a prescription?
The pharmacist should return the prescription to the customer allowing him/her to bring it to another pharmacy of their
choice. If it was an electronic prescription sent directly to the pharmacy, the prescriber will need to send the prescription to
another pharmacy of the patient’s choice. The patient is also encouraged to consult with the prescribing practitioner.
Individuals who would like to file a complaint—and can cite clearly the reason for the complaint by referencing applicable
statutes and regulations of the corresponding prescribing and/or dispensing board—can fill out a Request for Contact form.
The form can be found at the following link: ‘https://www.commerce.alaska.gov/web/cbpl/Investigations.aspx.
Alaska Board of Pharmacy – ProfessionalLicense.Alaska.Gov/BoardOfPharmacy
Alaska State Medical Board – ProfessionalLicense.Alaska.Gov/StateMedicalBoard
Alaska Board of Nursing – Nursing.Alaska.Gov
This article reeks of a bruised ego and a lack of knowledge. Medical science relies on empirical science and has a duty and obligation to do so without regard to popular culture. The pharmacist is equally responsible with a physician with regard to patient care. The vast majority of doctors would agree that the pharmacist is better educated and more knowledgeable concerning drugs and their interaction with human physiology.
Ivermectin is yummy.
Get over yourself.
Additionally, Dr. Jill Crista, cited in the article, holds a doctorate but holds an NP. This means she is not a physician. Seems a bit misguiding. Here’s an article from the AMA:
‘https://www.ama-assn.org/practice-management/scope-practice/whats-difference-between-physicians-and-naturopaths
Svidri, you can try to shill all you want for a corrupt and predatory medical-pharmaceutical industry run amok, but the more you do, the more you lose all credibility.
Go peddle your pro-establishment propaganda elsewhere, you quisling.
We have a family member who has been a pharmacist for 12 years. He is not happy with the way pharmacists are being dictated to by corporate bosses to 1) give every vaccine under the sun whether the patient wants it or not, 2) call care providers and hassle them about patients on opioid medications for pain, and 3) deny filling prescriptions the corporate bosses have said are not to be dispensed. On top of that are the insurance companies (coupled with federal/state agencies) holding pharmacists feet to the fire if patients do not refill their medications proving they are taking them as prescribed. Apparently it is the fault of the pharmacist if patients are not complying. Our family member said there are legitimate reasons for pharmacists to call care providers as in 1) prescription not written clearly or accurately, 2) drug prescribed will interact with another medication patient is taking or duplicates another one patient is on.
Walgreens pharmacist wouldn’t fill my Coof script, and threw it in the trash.
I would hope that a medical provider would have confidence in working together with pharmacists to approach a mutual understanding in situations like this. It’s saddening that a Nurse Practitioner can stand on such a soapbox and reach this many ears, calling for punitive action against DOCTORS of pharmaceutical science. In times like this, where ‘home research’ means consumption of diatribes from demagogues, trust in medical experts has never been more critical. There are constructive ways to seek change in the medical community, and there are proper channels to report real wrongdoing. Kristen, I encourage you be more respectful to your peers in the medical community.