Tuesday, October 09, 2012

Why We Can't Have Nice Things

Two groups of health care professionals I've developed a deep respect and reverence for are nurses and pharmacists.  Both have the time and are willing to take that time to answer questions a patient might have.  I've especially appreciated the fact that the pharmacists I've dealt with keep track of the medications I'm on, especially when those meds are prescribed by different doctors.  They spot when there's a potential interaction issue and alert both doctors to any problems.  They also explain why it's important to take the med in a specific way and to complete a prescription unless the doctor says otherwise.

 Those are just a few of the reasons why this column by David Lazarus was like a punch to the midsection.

You already knew that our healthcare system is screwy. But you probably didn't know that at least some pharmacists at CVS, the nation's second-largest drugstore chain, were refilling prescriptions and submitting claims to insurers without patients' approval.

The bizarre, possibly illegal practice was spelled out in confidential emails sent this year by a CVS pharmacy supervisor to dozens of pharmacists under his control.

The emails make clear that an internal quota existed for prescription refills, with at least 30% of calls to patients about their medications expected to result in return business. A threat of "major personnel changes" was made to pharmacists who couldn't hit their quota. ...

CVS acknowledges that the emails were legitimate and that prescriptions may have been processed without patients' say-so. But the company says this is an example of an overzealous manager going too far, not a practice followed by CVS pharmacists nationwide.

"It is not our policy to refill prescriptions without a patient's authorization," said Mike DeAngelis, a CVS spokesman.

Never mind that Barna described his instructions to pharmacists in one email as being among CVS' "best practices." And never mind, as I've reported before, that the company has had incidents in California and elsewhere of enrolling people in its automatic-refill program without approval.

I don't use CVS, I use one of its competitors.  We have a deal:  a few days before I'm due to finish the current cycle I get an email from the pharmacy reminding me of that fact and asking me to call to confirm I'll be refilling it.  It works for me.  Lazarus points out that the CVS has a similar program in which the pharmacist is to call the patient several times.  Apparently Mr. Barna wanted the pharmacists he supervises to go beyond that by refilling the prescription and billing the insurance carrier for the refill without the patient's approval.

As Lazarus points out, if the prescription isn't picked up, it's returned to stock and the pharmacy reimburses the insurance company.  No harm, no foul, right?  Wrong.  First of all, the extra paperwork and accounting costs the insurance company, something it will cheerfully pass on to the insured the next time premiums come up for review.  More importantly, however, the practice can actually harm the patient directly:

But one consequence of CVS' practice, the insurance spokeswoman said, is that a patient who tried to fill a prescription elsewhere during that time may have found that CVS had already secured reimbursement for the order, thus preventing the patient from dealing with the pharmacy of his or her choosing.

It could also slow a patient's access to medicine until the insurance issue had been addressed.

It's a lousy practice, and I hope CVS is embarrassed enough to slap the supervisor hard so that this practice is halted.

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