Two residents were affected by the practice discovered during a September inspection. One resident's Austedo medication for depression costs $6,000 for a 14-day supply. Another resident's Vraylar 3 mg for depression costs $700 for two weeks. A third resident was denied Ozempic 1 mg for diabetes treatment.
Billing director V11 told inspectors the medications weren't filled "because staff handwrote a note on the medication list that stated, do not send or not while at facility." She said she didn't know who wrote the notes blocking the medications.
The facility's nurse practitioner wasn't told about the practice. V23 discovered on September 16 that staff had written handwritten notes preventing her prescribed medications from reaching patients.
"The facility staff don't have the authority to not fill physician prescribed medications and it most definitely should not be occurring," V23 told inspectors.
For the resident denied depression medication, the consequences could be severe. V23 explained the patient "has multiple mental health diagnoses including major depressive disorder and abruptly stopping any of those medications including Austedo and Vraylar to treat her major depressive disorder could cause her to downward spiral into a deep depression and ultimately, she could be so depressed she commits suicide."
The diabetes patient faced different risks. V23 said the resident "wasn't prescribed any other medication to treat diabetes while at the facility" and she wasn't aware staff had blocked the Ozempic. Had she known, "she would have at least ordered staff to check R3's blood sugar a few times a day and if it was high she would've prescribed sliding scale insulin."
V23 identified the motive behind the medication blocking. "She knows why the facility isn't filling all the resident's medications, it's because residents on Med A have the facility is responsible for paying for their medications and the facility is always harping her to prescribe lower cost medications and she can't sometimes."
Administrator V1, Assistant Director of Nurses V3, and Regional Nurse Consultant V24 all claimed ignorance when confronted September 17. They said they weren't aware of staff writing notes to block medications.
V1 blamed the pharmacy for not questioning the handwritten notes. "Pharmacy staff should've questioned that because they know facility staff do not have the authority to document a note like that and not to send the medication or notify her or V2, Interim Director of Nurse of what's going on so they can look into it."
The facility operates under a $200 medication threshold policy. V1 explained that "when there is a high cost medication the pharmacy emails her a high cost form that documents the current prescribed medication and an alternative lower cost medication and she forwards these forms to the provider, the provider ultimately decides what medication is to be prescribed and the facility will pay for it if the resident is on Med A."
Nobody admitted to writing the handwritten notes that blocked the medications.
When pressed by email the day after the inspection, V1 provided a different explanation. "We do not have a formal policy, we request pharmacy provides alternatives and recommendations regarding medications over $200 that must still be approved by the resident physician. No one goes without medications, if there is no alternative to a high cost medication or the physician declines an alternative/generic, the medication is still provided to the resident."
The facility's own policy requires staff to "fax or call the orders to the appropriate pharmacy as needed" and "notify the resident's physician (if not the prescribing physician), for verification if applicable." The policy makes no mention of staff authority to block medications with handwritten notes.
The practice directly contradicted the nurse practitioner's medical judgment. V23 had prescribed specific medications for specific conditions, but facility staff prevented those prescriptions from being filled without her knowledge or consent.
For Medicare Part A residents, nursing homes are financially responsible for medication costs during their stay. The inspection revealed how this financial pressure translated into staff taking unauthorized action to block expensive prescriptions, even when no alternatives existed for serious medical conditions like major depression and diabetes.
The resident denied depression medication remained at risk for a dangerous downward spiral, while the diabetes patient went without their prescribed treatment, unmonitored by the medical staff who didn't know the medication had been blocked.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Evercare of Breese from 2025-09-18 including all violations, facility responses, and corrective action plans.