CVS under investigation for illegally refilling prescriptions to meet quotas

[Crazedclerkthe2nd]

http://www.latimes.com/business/la-f...,5604990.story

Summary: CVS is under investigation for refilling prescriptions without the consent of customers. Apparently pharmacists have prescription quotas to meet and have, in some instances, been encouraged to improperly refill medications without customer consent.

In one instance, Pharmacists were told to make their quotas or face "major personnel changes".

Apparently the major intent behind the quotas/push for prescriptions stems from the fact that, as soon as a refill is processed, CVS gets to bill insurers for it. Then, if a customer tries to get that same refill done at a different pharmacy (because CVS never told them it was filled), they are denied and must then fight with their insurance company to get the issue straightened out.

The official response from CVS is that employees are "never directed to refill prescriptions without customer consent". They also categorically deny any quotas exist.

.......

I posted a thread on CS awhile back discussing at length, the way businesses put way too much focus on certain metrics and let employees know meeting them is critical...if they want to stay employed. Thus, employees result to all sorts of questionable means to make their numbers. This can include tactics that are unethical or illegal or both.

This particular case makes me REALLY upset because we aren't talking about extended warranties or store credit cards, we're talking about medicines. You know, those things that some people NEED TO LIVE?

Imagine that you need a medication that helps you manage a chronic condition and your pharmacy tells you they have to charge you full price for it because your insurer denied their claim. Perplexed, you call your insurer and find out CVS filled it. That means you can either go to CVS to get your medication or have them cancel the claim so you can get it elsewhere.

This whole process can sometimes take days. Sometimes it only takes a few days without a critical medication to put a person in a very precarious situation.

And so we have a company CVS, playing games with peoples lives in the relentless pursuit of profits.

I hope there are serious repercussions for this.

[crashhelmet]

How many of these prescriptions are for drugs that are popular on the black market? Pain killers, viagra, antibiotics, etc. There's quite a bit of money to be had in selling a script that someone doesn't pick up or even know they have available to them.

[Mongo Skruddgemire]

I have a major problem with CVS anyway. I went in with a script for my wife to get filled. It was for a three pill series of Diflucan. Normally this is only issued in one pill or at most two but some women get yeast infections a bit stronger than that and so a three or four day dose is prescribed.

However, the insurance company (I could start a whole series of fratching threads on how our modern medicine system is ruled by bean counters with no medical training whatsoever making medical decisions) did not approve of paying for the three-pill dose and CVS refused to fill the scrip other than for the two that they *did* approve of.

So I asked how much would it have cost if we did this without insurance. Three pills can't be all that expensive after all. They refused to tell me saying that the insurance turned it down.

I said it didn't matter who turned it down as I was willing to go "Cash and Carry" on the doctor's original script. They again stated that the insurance company refused and so they could do nothing.

Now I went on a lengthy tirade of how insurance companies are not doctors and if a trained medical practitioner prescribes a medication or a procedure and a person does not have insurance *but* has the money to pay for it, then it can be filled/done.

CVS Agreed with me on that. Yay! Now we're getting somewhere! So can I have the medication? The full three-pill dose?

NO! Your insurance refused it.

Mothersmurfer!.

So at this point I gave up and asked for the script back. The fuckers would not even give me the script back so I could take it somewhere else. All the while stating (sing along boys and girls) "Your insurance company turned it down."

So then I went into a Customer's Suck worthy tirade of verbal abuse at the level incompetence (although is it really CS worthy if I was honestly in the right and they were being assholes?) and mind-numbing stupidity.

There was a police officer outside on another matter (traffic stop I believe) and they asked him to come in and escort me out. I told the officer that I'd be willing to do so quite cheerfully if they would give me the prescription. He asked and they refused saying (do I really need to repeat it again?) the usual bit and so he looked at me and told me that I had to leave...now.

Not wanting to be handcuffed I allowed the officer to escort me out. He talked to me to find out what the problem was and so I explained the encounter up until the point where he entered. He sighed and told me to wait right there. Five minutes later he comes out and tells me that they're not giving it up because it was already in the system as being filled and they can't release it because it would be fraudulent charges to the insurance company.

I looked the officer right in the eye and said "If they told me that I'd have been pissed off but would understand and I wouldn't have been banging my head against the wall of their stupidity." He looked sympathetic and informed me that I was banished from that store. I said I wouldn't go back in there if the hounds of hell were nipping at my heels and it was the only safe place on the planet.

He chuckled and we went our separate ways.

Called the doctor, they told me to come in and they gave me a new script, I called the insurance company and informed them that I did not receive the medication and to not pay CVS (giving full details as to why and how I was not even allowed to go in to the store even if I wanted to pay my copay), went to the doctor's office, got the new script, went to Walmart, told them that insurance was *NOT* to be involved, they filled the script and told me the cost of the generic Diflucan.

A whopping $5 bucks per pill totaling $15 dollars. Five ($5) dollars *less* than my $20 copay had I gone through insurance.

So understandably I have a rather low opinion of CVS

[wolfie]

How many of these prescriptions are for drugs that are popular on the black market? Pain killers, viagra, antibiotics, etc. There's quite a bit of money to be had in selling a script that someone doesn't pick up or even know they have available to them.

I can understand the pain killers (which, based on what I've read, are not PERMITTED to be renewable) and viagra having "street" value, but why would antibiotics be popular on the black market?

[AdminAssistant]

but why would antibiotics be popular on the black market?

I'm guessing here, but I'd imagine people who have infections but for whatever reason don't want to go to the doctor. I'm thinking, junkies with infections from dirty needles, etc.

[Panacea]

I can understand the pain killers (which, based on what I've read, are not PERMITTED to be renewable) and viagra having "street" value, but why would antibiotics be popular on the black market?

I'm guessing here, but I'd imagine people who have infections but for whatever reason don't want to go to the doctor. I'm thinking, junkies with infections from dirty needles, etc.

That, and some people like to stockpile antibiotics in case of the next "epidemic scare." Cipro was very hard to get after one such scare; perfectly health people wanted scripts to have "handy" in case they needed. Ditto Tamiflu.

Mongo's story is outrageous. I have had plenty of pharmacies tell me that a script is not covered by insurance; would I like to use another method of payment? At that point I either pay cash or not. And I can always get a script transferred to another pharmacy; I've done this while traveling any number of times.

I've never been impressed with CVS's service, but now I have reason to actively avoid them. Sounds like this particular problem is endemic.

[Crazedclerkthe2nd]

However, the insurance company (I could start a whole series of fratching threads on how our modern medicine system is ruled by bean counters with no medical training whatsoever making medical decisions) did not approve of paying for the three-pill dose and CVS refused to fill the scrip other than for the two that they *did* approve of.

So I asked how much would it have cost if we did this without insurance. Three pills can't be all that expensive after all. They refused to tell me saying that the insurance turned it down.

Mongo, it sounds like you may have gotten caught in the scam I posted about to start this thread. Wouldn't surprise me for a minute if those CVS workers had been "strongly" directed to NOT cancel scripts once they've been entered. In this case, they were hoping to pocket the insurance money from the two pill version, which they wouldn't be able to do if they cancelled it and sold you the three pill version outright.

[crashhelmet]

Antibiotics are also sold illegally to those that don't have insurance and think they can't afford to buy them from a pharmacy. I know people that were going to down to places where you could buy antibiotics for horses over the counter and just cutting the dosage.

[bara]

This is a reason why I say health care should not be a for profit business.

[Duelist925]

This is a reason why I say health care should not be a for profit business.

Once the bottom line becomes the goal with peoples health and lives on the line, people will, inevitably, suffer.

[insertNameHere]

I can understand insurance going NO you don't need Brand Name Y when Generic Y is chemically the same...
But trying to say. NO, you only need TWO days of the Three your doctor ordered
or how about 900mg instead of the 1200mg...

Well that is just fucking stupid. As far as Mongo's horror story, HOW in the hell could the prescription for THREE pills be filled when they only would allow you two, Obvious it was not properly filled so the pharmacy was CLEARLY defrauding the insurance company.

[Mongo Skruddgemire]

Well that is just fucking stupid. As far as Mongo's horror story, HOW in the hell could the prescription for THREE pills be filled when they only would allow you two, Obvious it was not properly filled so the pharmacy was CLEARLY defrauding the insurance company.

Actually there was no fraud. My insurance company said "only allow two" and the pharmacy only filled two.

As I never picked up the order, they would have after a certain time frame pulled the meds and put them back on the rack (blister packaged) for someone else. Should I have come back they would have made me wait and filled them from whatever stocks they had on the shelf.

Until I pick up and pay for the meds, they can't charge the insurance.

What they should have @#$%ing done was let me pay for the meds myself without the insurance. But they stamped the order and so couldn't give me the script back.

Which is all they needed to have told me. I'd have still been miffed, but I wouldn't have gone thermal over it. I was livid because they told me "not gonna to it neener neener neener." with out said explanation.

[AccountingDrone]

I had an issue with losing almost 2 weeks worth of meds and found it easier to get a scrip for 1 month of meds from my doctor and going to Walgreens and paying cash for them than arguing with Tri-care and CVS. Though I did manage to get my meds early one cycle by pointing out that they do not have CVS in Germany - and providing copies of the plane ticket with the 2 month timeframe plainly marked ...

[EricKei]

That, and some people like to stockpile antibiotics in case of the next "epidemic scare." Cipro was very hard to get after one such scare; perfectly health people wanted scripts to have "handy" in case they needed.

I had something related to this thanks to a relative some years back. My father had been bitten by a spider that got into the house and had a nasty infection because of it (he was also diabetic, which probably didn't help). We went to the ER on that day, the doc looked him over, and he prescribed about ten pills of a powerful antibiotic to keep it under control/clear out the infection.

My uncle, at the time, was an MD at another hospital, and was able to get us enough of the pills from his sample drawer (pharma companies routinely give doctors free samples to give out to patients as a form of advertising) to fill that script -- the pills were about ten bucks each at stores, and we were, shall we say, in a situation where we really couldn't afford to be out a hundred bucks on no real notice...

Long story short, Uncle Doc got the pills and had his wife pick them up to bring to us....She never brought them, explaining that she was going to save them for the next time her kids got a bad cold or infection >_< Of course, it took a few hours before we knew that this was happening... Frighteningly enough, she honestly didn't understand why we were freaking out/why this might not have been the best course of action.

I ended up taking the script to a 24 hour pharmacy at midnight to a part of town I really would have preferred not to be in, to literally write a check for money I didn't have (mea culpa, bad customer! ) to get those pills. By the time Uncle Doc found out what had happened, we had already obtained the pills (which, fortunately, worked like a charm ).

[Aethian]

So what did Uncle Doc do to his wife after finding out that she could have severely hurt/killed his brother?