This is an interesting story about securing business and this just happens to be the prescription business.  A patient goes to another pharmacyimage to fill a prescription due to the fact that his normal pharmacy was out of the drug.  While there he gets his prescription filled and gets enrolled in an auto refill program.  Well next month he goes back to his normal pharmacy and the CVS prescription got automatically refilled and billed his insurance on top of that.  Sure it took a person to initiate the auto refill program but once that was done “the algorithm goes in motion” and does it’s work with auto refilling the prescription and billing it.   

In essence this is no different than the actions we see in the financial markets with parameters being set to a “when”, “if” “where” or “as” clause comes into play with the way an algorithm is written.  That’s the SQL language that drives all of this technology.  “When” 30 days is up, and “if” the patient has not manually called for a prescription and picked it up, the program goes into motion.  So this article makes a good point to have the patient sign before someone can put the algorithms in motion to auto refill.  We all know that there are incentives and pay for performance programs in place for pharmacists today and here’s a good example right here where the insurance company pays the pharmacists for enrolling patients in a program they support.  Sure some of this is a good idea if it is in need, but how much of this might be done to make a buck only?  In this case United gets some additional data to mine to diagnose sub-clinical conditions. 

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

Pre-clinical diagnosing also has it’s issues as to how far does it go? 

“Previvor, If You Develop the Disease You Get Off the Island”–Subclinical Illnesses Leading to Overtreatment And Possibly Death–Ivan Oransky From Reuters Video

So again one starts to wonder how much advice is imagegiven to get you healthier and how much of this is done to make a dollar?  Back to this story with locking the patient into the refill program CVS is assuming they are going to refill all the prescriptions and you get enough of these types of situations the old business intelligence software for projecting sales comes into play and winds up being part of a presentation on dollars expected to show shareholders.  All the patient knows is that they need their medication and the pharmacist just wants to earn an extra dollar and neither have the full picture of how this all plays out in large numbers, so the consumer gets it again for those sales projections made to sell stock.   What a shock the patient received when he went back to his regular pharmacy and was told he would have to pay $600 as the auto refill kicked in at CVS and was filled there as well as being billed to his insurance.  

My mother had a situation with refills for her glucose strips in where she was getting over loaded with strips as she tests twice a day and the pharmacy said she had to do it 3 times a day and she’s been testing for over 20 years.  That caused havoc too as she didn’t want the waste of the strips but the drug store didn’t have a “model” to auto refill based on 2 times a day so here you go again with pushing out the prescriptions.  This went all the way back to the doctor and insurance company dueling with the pharmacist too in the fact that both said twice a day was fine.  See how this works for money when the algorithms get in place?  BD 

All businesses want people as repeat customers. And when it comes to drugstores, that means they want you to keep refilling prescriptions.

But you'd think they'd ask first before signing you up for automatic refills and billing your insurer.

In the case of CVS Pharmacy, the country's second-largest drugstore chain, after Walgreens, the official policy is that customers' approval is always sought before people are enrolled in the company's ReadyFill program.

But B.G. Stine, 52, of Torrance had a decidedly different experience when he stopped by a CVS branch to fill a couple of prescriptions for his brother, Mike, who has Parkinson's disease.

A month later, it was time to get the prescriptions refilled. Stine went, as usual, to the retirement community's pharmacy to pick up the drugs.

This time, the pharmacist informed him that he'd have to pay the full $600 price for the medications that had been out of stock last time. CVS apparently had already filled the prescriptions and billed Mike's insurer.

The way things stand, a pharmacist signs up people via computer. There are no forms or written authorizations.

This is obviously a problem, as Stine's experience makes clear. While CVS' official policy may be that the customer calls all the shots for ReadyFill, an unscrupulous (or bonus-minded) company worker can easily cut corners and sign up anyone without his or her knowledge.,0,2146386.column


Post a Comment

Google Analytics Alternative