“Put Up Your Hands, Asshole”. More Damning Evidence on CVS from the Los Angeles Times

Jp Enlarged

U.S. investigating CVS prescription refills

Thanks to Peon for digging this out for us.  Many hands make light work.

latimes.com

U.S. investigating CVS prescription refills

A Justice Department unit is investigating claims that refills were made without customer approval. The inquiry will focus mainly on Medicare fraud allegations.

David Lazarus

3:00 AM PDT, October 19, 2012

The U.S. Justice Department’s civil fraud division is investigating claims that CVS Caremark wrongly refilled prescriptions and billed insurers without the knowledge or the approval of its customers.

The probe will focus primarily on allegations of Medicare fraud, said Shana T. Mintz, an assistant U.S. attorney in the division’s Los Angeles office.

The investigation also will look into whether CVS violated a $17.5-million settlement reached with federal authorities last year over allegedly falsified claims to Medicaid programs in California and nine other states, Mintz said.

CVS has denied doing anything wrong.

The Justice Department will be working with the U.S. Department of Health and Human Services, which late last week launched its own investigation. California and New Jersey regulators also are probing CVS’ refill practices.

Mintz said that her office has contacted CVS and that the nation’s biggest provider of prescription drugs is prepared to cooperate.

A key issue is whether CVS pressured pharmacists to increase refills — and hence revenue — through use of internal quotas that made pharmacists’ pay and bonuses contingent on how many patients they could enroll in the company’s automatic ReadyFill program.

Company spokesman Mike DeAngelis said the drugstore chain uses so-called performance metrics to improve operations, not to determine employees’ compensation.

“These metrics are among the numerous factors used to measure the effectiveness of our pharmacy services, and it would be inaccurate to describe them as quotas that put pressure on individuals,” he said.

But 16 current and former CVS pharmacists, all of whom requested anonymity because of fear they could lose their jobs at the company or at other pharmacies, said this simply wasn’t true.

One pharmacist described a “never-ending cycle of frustration” resulting from patients receiving automated calls about refills of prescriptions, or scripts, they never ordered.

“We have to pretend that we have no idea how it happened,” the pharmacist said. “Everyone involved knows what this really is: a way to fill more scripts and make more money for the company.”

The company reported $56.6 billion in prescription sales last year, about half its total revenue, from its store and its online pharmacy operations. Walgreen, by comparison, garnered $45.1 billion in prescription revenue last year, or about 62% of its total sales, according to market research firm Pembroke Consulting.

Virginia Herold, executive officer of the California Board of Pharmacy, said state officials have received numerous complaints about Californians being enrolled in CVS’ ReadyFill program without their approval.

Documents for a meeting of CVS pharmacists in May outline what the company calls its “key business metrics.” They show the targets that pharmacists are expected to reach for a variety of activities. The Times obtained the documents from two company pharmacists.

CVS tells pharmacists that they’re expected to enroll at least 40% of patients into ReadyFill.

Document: What CVS pharmacists were told

In an earlier column, I quoted an email from a CVS supervisor in New Jersey who warned pharmacists that “each of you owns scripts and has an obligation to meet your weekly script budget; this is one of the areas you’ll be evaluated on come review time.”

The documents from the May meeting provide CVS employees with examples of how a “high performer” thinks, compared with an “average performer.”

The high performer, according to the documents, understands that “ReadyFill is the key to my store’s success. If we get ReadyFill right, everything else will follow.”

The average performer, the documents noted, says that “we automatically enroll patients in ReadyFill for maintenance meds. It helps our score.”

By CVS’ standards, therefore, an average pharmacist automatically refills people’s prescriptions regardless of whether they ask for it.

The documents also detail “enhancements” to what CVS calls its Patient Care Queue, a computer system that contains information about every patient and the medications they’re taking. The enhancements include “opportunities” to refill outstanding prescriptions.

The system tracks the percentage of patients not on ReadyFill and those who are.

Document: CVS Pharmacy Business Metrics

To be sure, some people may fail to take their medications regularly, and that can have serious healthcare repercussions. CVS and other pharmacies are behaving responsibly when they take the initiative in encouraging compliance with doctors’ orders, which might include automatic refills.

But CVS seems to have taken this objective to a different level by creating metrics that measure nearly every activity undertaken by a pharmacist.

A training manual provided to drugstore employees shows that they’re graded on everything from an individual store’s profits to how long a patient’s prescription waits to be picked up. To reach the quota for refills, CVS pharmacists are instructed to call patients at least three times to pick up their medicine.

The documents from the May pharmacists’ meeting stated that CVS aims by the first quarter of 2013 to “develop effective strategies for addressing the most common patient objections” to having prescriptions automatically refilled.

The company also intends to “create guidelines for effective motivational communication” when a patient balks at a refill, such as “asking open-ended questions” that discourage one-word answers. Example: How do you feel when you take your medication regularly?

CVS pharmacists said these meticulous “best practices,” introduced over the last couple of years, have resulted in a high-pressure environment in which employees feel their jobs depend on meeting company quotas.

“If you do not meet your targets, you face writing action plans to better improve it and write-ups for poor performance,” a second California pharmacist told me. “Also, you need to know that if the metrics are not met by your review, you receive a ‘needs improvement’ and therefore no raise.

“Many pharmacists, including myself, have not seen a raise in two years,” the pharmacist said.

A third CVS pharmacist in California said employees share the goal of making sure people take their meds. They’d just prefer a less profit-focused approach.

“Sure, some pharmacists just want to get the scripts done and never speak to a patient, but there are also those who will want to know why a patient isn’t taking a certain medication anymore,” the pharmacist said.

“Do they have side effects that are bothering them? Are they struggling financially with co-pays? Are they aware that they can use a pill box to help them, especially if they are elderly or have a lot of medications?

“That is the right way to improve compliance, by getting down to the bottom of the problem,” the pharmacist said. “Not filling scripts like a factory … and having patients build up stockpiles in their house because they can’t get off our calling list.”

Complaints can be filed with the California Board of Pharmacy at http://www.pharmacy.ca.gov. State officials said they will coordinate their investigation with federal authorities

36 Comments

36 Comments

  1. cvsconsumesyoursoul  •  Oct 20, 2012 @3:32 pm

    Saw this last night. I’m waiting for the damage control conference call. I’m telling you it’s time to hit with a downtime filling story..

  2. Whistleblower  •  Oct 20, 2012 @4:59 pm

    More to come… That’s all I can say for now!

  3. pharmaciststeve  •  Oct 20, 2012 @5:29 pm

    How much longer before Merlo – and some of the other numb-nuts at the top of the management pile – is reaching for the rip-cord on their “golden parachute” ?

  4. YoungGun  •  Oct 20, 2012 @5:57 pm

    This is how we get the Metrics train derailed. We need to bring light to these dark corners of the pharmacy world for all to see. It should be fun to watch the upper management cronies scatter like roaches. Read your company’s P&P!

  5. riteaidjoe  •  Oct 20, 2012 @9:10 pm

    I wonder when all the other chains will get the screws put to them. RAD, WAG, Wal-mart etc…wouldnt it be sweet if this was just the begining.

  6. Pharmacist Bobb  •  Oct 20, 2012 @10:25 pm

    CVS should be required to be broken up into smaller new companies with restrictions such as no expansion. Caremark would be out of the picture. Merlo still needs to be made an example of as he is a pharmacist in charge so to speak.

  7. Pharmacist Bobb  •  Oct 20, 2012 @10:39 pm

    If you don’t do what is expected–what happens? Expected sounds threatening to me, threatening to my lively hood, threatening to my family, threatening to my profession! I think there is no choice but to enroll every person into readyfill whether they like it or not or I and my family may starve.

  8. MSDEMEANOR  •  Oct 21, 2012 @4:39 am

    No expansion?
    Are you out of your mind?
    No expansion means no jobs.
    The best job security is the ability to walk away and find another one.

  9. Peon  •  Oct 21, 2012 @8:05 am

    riteaidjoe, I work for Wal-Mart and they are quickly moving in the direction of CVS and RiteAid with regard to metrics. From what I read on this forum, they are not near as bad as those two sorry chains….yet. What we need is for some real action to take place against CVS and all their metrics. That might deter the other chains from pushing that crap. And, it is crap! It is nothing more, pure and simple….CRAP!! The only real measure of a business is whether it is making money and how well the customers like the business. All this other stuff is CRAP!!! A pharmacy may excel at these metrics, but turn out to be a disaster waiting to happen. I know of one Wal-Mart pharmacy that is excelling at the metrics. But, the pharmacy manager is setting the pharmacy up for a lawsuit because he is not giving the techs their breaks….a very big no no with Wal-Mart. They have been sued so many times over this one thing that they adamantly require techs to get their breaks. For reasons like this, metrics are nothing more than CRAP! These chains are setting themselves up for major problems. Mature pharmacists are not going take the job as PIC for some of these sorry chains. What you have are fresh out of pharmacy school grads that don’t have the experience to manage a business.

  10. pharmacyslave2000  •  Oct 21, 2012 @8:23 am

    I have to wonder, will this be a death-blow for the profession? If the largest pharmacy chain is rendered impotent by the federal gov’t, what happens to the employees and the profession? If other chains have to change, will the business still be profitable? RAD is barely hanging on. This could effectively kill two companies and dump thousands of pharmacists into a rapidly shrinking employment pool. We, as pharmacists, always seem to be on the short end of the stick when things change. As the old saying goes,”be careful what you wish for because you just might get it”.

  11. cvsconsumesyoursoul  •  Oct 21, 2012 @8:32 am

    Interesting…readyfill is strangely absent this morning. Seriously though. If you work for cvs and have any info or threatening emails regarding downtime or readyfill send them to David lazarus. Downtime should be the next focus.

  12. Pharmacist Bobb  •  Oct 21, 2012 @8:49 am

    MSD-future expansion would come from new companies, new independent pharmacies and other chains who haven’t been spanked time and time again and forgot their lesson!

  13. the truth  •  Oct 21, 2012 @9:18 am

    Congrats to the LA Times and their reporting. So much of what we do is a waste of time and money (something the bigwigs don’t comprehend). I may not have a degree from Wharton but I’m damn smart when it comes to business operations. You can’t push what people don’t want. Yesterday I saw a gentleman who was on ready fill and he had 3 different strengths of the same med filled in 2 weeks. All were replacements for the other med. I was fortunate enough to speak to his wife who told me what the correct strength should be. I immediately took him off of ready fill (he never asked to be on it). I also blame the bad rphs in our district who didn’t bother to do a proper DUR and question the drugs. I did. If he had taken all of them, and some people do because they are not informed, his BP would be way too low. The chains need to wake up and clean house. Fire the idiots at the top who come up with this crap. Hire good or great rphs and get rid of the bad (send them overseas) and give the staff a lunch break (close the pharmacy down for a 1/2 hour). We have one doctor who takes a 3 hour lunch break. Why can’t I have a 1/2 hour out of my 12 hour shift? Save your documentation, your emails from the company (print them out). I have for years just in case.

  14. cvsconsumesyoursoul  •  Oct 21, 2012 @9:20 am

    Now the system went down again. Thank god for nfl Sunday ticket. Not filling shit during downtime and putting my patients at risk as well as my license.

  15. cvsconsumesyoursoul  •  Oct 21, 2012 @10:40 am

    Ready full still MIA…

  16. bcmigal  •  Oct 21, 2012 @10:54 am

    Read the LA Times article online and open the documents. There is a statement: “Recent graduates are typically targeted for hire as patient care skills are increasingly part of the core curriculum.” (Anyone over 30 need not apply?)
    I cannot blame any of the “bad” pharmacists. The threats might be veiled but they do most definitely do exist. At our last meeting, “concern” was expressed for the more experienced pharmacists (who were mentioned by name) who might not be able to “cut it”. Does anyone else see that as offensive?

  17. Pharmservative  •  Oct 21, 2012 @11:41 am

    I think everyone is seeing something that ain’t there. Worst case there is a big fine and the cost gets passed to Rph saleries. Maybe a change in how ready full works. If you work for cvs this is a bad thing. The environment won’t change. If anything we lose readyfill and hours are cut due to less scripts and paying for the fine. You’re crazy if you think it will make things better

  18. pharmaciststeve  •  Oct 21, 2012 @12:00 pm

    Let’s assume that things are going to change… we get more help and meal breaks… profits go down.. might give corporate pharmacy the incentive to not accept those low ball PBM contracts.

    The PBM’s will react in a huge push to get everyone to go to mail order… that is not going to work for many Rxs…

    We will have to take the stand – and stick to it – when pts come to us when their mail order had not come thru… IT IS A CASH SALE… we don’t have a contract… If they don’t like our CASH PRICE… they can call their mail order pharmacy…

    Human psychology is that pt/customers/people only get their ass in gear and do something when they are inconvenience.

    right now… with these people.. we expend much more time/money trying to help these people than we receive.. and they are either mandated or chose to use mail order the rest of the time… we are doing nothing more than allowing them to stay happy with their mail order firm…
    We are allowing them to steal time from the rest of our faithful pts.. that are our bread/butter.

    I suspect that it would only take a couple of years before we have state/fed laws that mandatory mail order is ILLEGAL…

    change will be neither transparent nor painless..but.. without change ..there will still be a lot of pain…

  19. cvsconsumesyoursoul  •  Oct 21, 2012 @12:06 pm

    Are you serious? So threatening employees to violate the law as well as threatening employee’s to fill in downtime (this violates federal computer system laws AND my state law) is something we all are imagining? Let’s not forget kpm as a component of pharmacists bonus, of which, university of pheonix spokesperson denied existed?

  20. the truth  •  Oct 21, 2012 @12:36 pm

    Soul, my friend called me from CVS about the downtime and the crashed computers which recently came back up. Do you feel the need to catch up on rxs or do you leave them for the next day with a note for the next rph? Personally, I don’t believe that rphs should catch up on the queue b/c it wasn’t their fault to begin with. I mean, sure you can do your best but it’s really CVS’s fault. Any opinions?

  21. pharmaciststeve  •  Oct 21, 2012 @12:49 pm

    @truth.. are you able to call in any extra techs to help catch up? screw the tech budget for the week… aren’t you suppose to keep the pt/customers happy? You can’t do it.. when the computer’s down time puts you hours behind… What is more important… breaking the law – filling Rxs when the system is down… or breaking the tech hrs budget?
    Dumping them on the next shift… especially since it is a Monday… could be the genesis of med errors… with that shift trying to catch up.. with all the pressures from customers wanting their Rxs called in both from Sun & Mon…
    there is no good answer… or right or wrong way… you use whatever resources available to you and do the best & safest job you can do… that is what PROFESSIONALS do using their PROFESSIONAL JUDGEMENT !

  22. the truth  •  Oct 21, 2012 @12:59 pm

    Relax, I don’t work at CVS anymore. My friends do. And they cannot call for extra help b/c you are only allowed so many hours. That is why most rphs leave the work for the others. Most busy stores I now always, I mean always, have 3 or 4 pages of queue that is red *overdue* b/c of downtime, and lack of help. I don’t blame them.

  23. cvsconsumesyoursoul  •  Oct 21, 2012 @1:34 pm

    CVS having only 100 days with of rx history with NO DUR/Interactions violates the definition of federal record keeping and probably the vast majority of state laws. We have no access to interaction software so no safety checks can be made nor can we look any up because everything is online. We have found at least 4 violations of my states pharmacy practice act today regarding downtime filling in its current form. These will be addressed soon as I’m about to report to my state board and any threats will be answered with their names and objections off to the board for further clarification. Then I go to the compliance officer.

  24. cvsconsumesyoursoul  •  Oct 21, 2012 @1:36 pm

    Btw..I clean everything up. I can’t stand a messy pharmacy. My volume often allows that though.

  25. Whistleblower  •  Oct 21, 2012 @2:03 pm

    We should all send a link to the LA Times articles to our local newspaper or television stations. Some markets just may get lucky!!!

  26. Pharmacist Bobb  •  Oct 21, 2012 @2:56 pm

    I recommend going to the LA Times link and adding comments there too. Email the link to your friend pharmacists and ask to forward to 10 more pharmacists and make it a chain letter. The chain must not be broken until we are unified as a profession. Your thoughts on this!
    http://www.latimes.com/business/la-fi-lazarus-20121019,0,1491028.column

  27. Pharmacist Bobb  •  Oct 21, 2012 @3:03 pm

    LOL Soul—Pheonix spokesperson Pharmservative is Osump or was it ohump with is new alias. He needs to get out of the trailer soon, there must be chemicals in the walls affected his thinking!

  28. Mookie  •  Oct 21, 2012 @7:25 pm

    Soul-

    Keep us posted on this. I questioned by boss about filling when the system is down and not being able to properly check DURs. I pretty much got a half-ass answer that didn’t do me any good. Of course, I keep documentation of the correspondence

  29. Pharmacist Bobb  •  Oct 21, 2012 @7:41 pm

    Now that they are proven liars, let the truth be told about labor too. It is a less than safe amount of labor needed. When they say you have enough help to get the job done we know it’s BS. That someone is doing it somewhere with that amount of labor is BS. This labor model is the truth, it is called skeleton schedule for a reason. They fucking metric everything yet they do not metric how many phone calls you get and how much time is spend on the phone with customers & insurance companies. Where is the metric of how much time is actually spent at the register. These numbers + volume and all that is “expected” should determine the real labor needed, not their cream in their pants wish number.

  30. pharmaciststeve  •  Oct 21, 2012 @8:49 pm

    @Mookie… why don’t you “interpret” what was in the email and send it back to him… for a clarification if your interpretation is correct. try to paint him into a corner on a answer…

    I was sent a recording of a meeting between RPH and a young DM/RPH.. I don’t know if the DM knew it was being recorded or not… but… I would bet dollars to donuts that he had been coached/trained in how to handle this matter of discipline… Unless this DM/RPH also has a BS/MS in Psychology.. I have yet to know anyone that young… to know all the “right words” in dealing with underlings in such situations.

    Our daughter has a MS Psychology/Family therapist and at times.. she will try that psycho-babble on me to get me to do things in a certain way… I know psycho-babble when I hear it…

    get your boss to commit in writing the truth… right now.. he could come back and say that he didn’t understand/misunderstood your question.. and dis-a-vowel his answer…

    Everyone needs to nail their shoes to the floor on such issues.. so they can’t squirm away…

  31. Pharmacist Bobb  •  Oct 21, 2012 @9:45 pm

    A couple of posts I like from the previous LA times article

    http://www.latimes.com/business/la-fi-lazarus-20121005%2C0%2C1097807.column#tugs_story_display

    Julie Everhart at 2:41 PM October 06, 2012
    As a past employee of the local CVS store here in North Carolina I applaud the LA Times for exposing this horrible practice. I parted ways with the chain after this practice was forced upon employees. Even if a doctor gave no additional refills we were ordered to submit requests for more refills even if we knew there were allergy issues such as a potential sensitivity. If each store did not reach their “quota” technician hours and support staff hours were cut weekly. Ever wonder why it takes forever and a day to get your medication? It’s because if we didn’t reach our number, our hours were reduced.In some instances pharmacists were required to write 1000 word essays explaining why their store did not reach the quota. Thats exactly what I want my already over-stressed pharmacist to be doing or worrying about while he/she is trying to correctly fill my prescription!!My breaking point came when I was forced to get refills on a 92 year old womans 1 time use of Premarin Vaginal cream and then call her to tell her she HAD to pick that medication up… thats when CVS and I parted ways. I refuse to compromise my principles or own personal values and beliefs to pad some corporate pocket. Kudos to LA Times!!!!

    This guy thinks like me!
    DGates at 7:04 PM October 4, 2012
    CVS should be shut down and their executives put in prison.

  32. Pharmacist Bobb  •  Oct 21, 2012 @10:20 pm

    Should Merlow be Bubba’s new girlfreind

  33. pharmaciststeve  •  Oct 21, 2012 @10:38 pm

    There have been law suits filed against the owners/corporate offices of NECC/Ameridose to freeze their personal assets to help pay damages.

    Could be the start of a new era in corporate america where upper management is personally held responsible for decision they made or were aware of and condoned them being implemented

  34. RPh Ed  •  Oct 24, 2012 @9:50 am

    This same thing happened at WAG all the time while I worked for them. We would have the store manager telling us to put everyone on auto-refill because his regional manager ( a non pharmacist ) was telling him to push auto-refills and that this is now policy. This year we were told that auto-refills that would account for our bonus and every week we received emails from the district office showing each stores auto-refills percentages with a note telling us that this was part of our job.

  35. Peon  •  Oct 24, 2012 @10:32 pm

    RPh Ed, when you say the store manager telling you to put everyone on auto-refill, are you talking about the non-pharmacist, variety store type manager? If so, why in the hell would you listen to him? And, how does he get to be your boss? Now, I can understand the non-pharmacist regional manager. Not being a pharmacist already qualifies him to be a first class idiot when it comes to pharmacy. The tying of your bonus with the auto-refills might be something you need to write the LA Times reporter about.

  36. Mike  •  Apr 23, 2013 @3:25 am

    This same thing happened at WAG all the time. I really like what you have write to your blog. Thank you

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