The LA Times has been doing a good job following up on this situation and I see it in Twitter all the time with pharmacists saying this happens a lot too.  We all know that pay for performance exists in the drug stores and some of what it is trying to accomplish is not bad and some of it creates data for sale as retail pharmacies make big money there, like Walgreens that made short of $800 million on selling data only so you could bet CVS is up there too.  Below is the first article on this topic from a few months ago.  Once the refill algorithm is set in place several things take place after that and items as such are making it difficult for consumers. 

The Automatic Prescription Refill Algorithm Causing Havoc at CVS When Not Personally Authorized By the Patient–Attack of the Killer Algorithms Chapter 40

This issue has to do with pharmacists putting prescriptions in for auto refills.  The Times has internal documents that show “refill quotas”   Corporate wise they say there are no quotas but pharmacists say it does play out on their evaluations.  CVS did  not want to respond.  There are emails from managers supervising pharmacists tell them about meeting their quotas.  This is typical whenever sales are being pushed, I had it from my manager when I was in sales but that was my job, a little different from being a pharmacist filling prescriptions.  The pharmacists don’t want to do this, and customers don’t want it but it’s the old game.  The insurance company gets billed when the prescription is filled, not when the patient picks it up.  The insurer is supposed to be refunded if this happens.  If a customer goes elsewhere to another drug store they can’t get it for around 2 weeks until it gets out of the system.  The insurer is not a victim here as they work with drug chains to set a lot of this up.  How can this be audited is one of the questions asked?  No wonder our premium are so high. 

Here’s a good example of where United pays pharmacists pay for performance money for those pharmacists that sign up consumers with the YMCA and other United plans, so maybe all these programs as they build and multiply are having a little conflict.  And again there’s the issue of making  money with data for sale too with not only prescription data but they have the capability to look at what else you purchase in the store as well, so are you getting insulin prescriptions and then buying a bunch of candy for one example?  They are all using predictive analytics these days everywhere they can. 

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

Here’s another situation I wrote about a while back with the strips for my mother’s diabetes machine and we had quite the time once the pharmacists told her she needed to check 3 times a day and had conversations both with her doctor and Health-Net, her Part D provider who agreed 2 times a day was fine as she’s been doing it that way for around 20 years.  The problem was the extra shipments of strips that were auto refilled and shipped. 

My mother gets her diabetes strips from Walgreens who also called her.  Again as I mentioned above she’s been a diabetic for years and does her testing as she should, and does it twice a day, but the pharmacy said she needs to do it 3 times a day.  The pharmacy also said they had her next prescription ready for her too.  To this she said, hold off as I am getting too much and I don’t want to have too much on hand that might expire before I can use it.

Walgreens was basing their prescription refills and her needs on 3 times a day when in fact she does it twice a day.  They finally worked with her to let Mom get her own refills “when she needs them” but the caller on the phone was adamant about doing her readings 3 times a day.

Translation: Mom is messing up the automated system her by doing it twice a day instead of 3 times a day I think <grin>. 

They may or may not have a parameter that can be added for twice a day, either that or it requires someone in a supervisory position to make that change or a programmer to add it as a selected choice for the patient based on communications.   I realize working with data how automation is set into motion based on parameters

Compliance Police Out In Force for Seniors–Health Plans and Drug Stores Making Phone Calls-Business Models & Caller Behavior Sucks -A Result of Pay for Performance Efforts?

Has your pharmacy ever refilled a prescription for you without your authorization?

Some customers of CVS have been complaining that that has happened to them.

Consumer columnist David Lazarus and Business Editor Marla Dickerson discuss the complaints, which Lazarus has written about in a series of stories in the Los Angeles Times.

CVS acknowledged the legitimacy of the emails but said the unauthorized refills were limited to about 50 East Coast pharmacists and that the supervisor involved wasn't following company policy,0,2419922.story


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