Are chain pharmacies repeating the errors that caused Wells Fargo to open unauthorized bank accounts?

by Jeff Sovern

A recent NY Times article, Chaos at Chain Pharmacies Is Putting Patients at Risk, reminded me of how the Wells Fargo quotas drove Wells employees to open unauthorized accounts.  There's a lot in the article, but here are two excerpts:

[CVS] Staff members were supposed to persuade 65 percent of patients picking up prescriptions to sign up for automatic refills, 55 percent to switch to 90-day supplies from 30-day, and 75 percent to have the pharmacy contact their doctor with a “proactive refill request” if a prescription was expiring or had no refills, the documents show.

* * *

Dr. Mark Lopatin, a rheumatologist in Pennsylvania, says he is inundated with refill requests for almost every prescription he writes. At times Dr. Lopatin prescribes drugs intended only for a brief treatment — a steroid to treat a flare-up of arthritis, for instance.

But within days or weeks, he said, the pharmacy sends a refill request even though the prescription did not call for one. * * *

Aside from creating unnecessary work, Dr. Lopatin believes, the flood of requests poses a safety issue. “When you are bombarded with refill after refill, it’s easy for things to fall through the cracks, despite your best efforts,” he said.

Pharmacists told The Times that many unwanted refill requests were generated by automated systems designed in part to increase sales. Others were the result of phone calls from pharmacists, who said they faced pressure to reach quotas.

In February, a CVS pharmacist wrote to the South Carolina board that cold calls to doctors should stop, explaining that a call was considered “successful” only if the doctor agreed to the refill.

“What this means is that we are overwhelming doctor’s office staff with constant calls, and patients are often kept on medication that is unneeded for extended periods of time,” the pharmacist wrote.

An unauthorized account is bad enough but unneeded medication can have serious health consequences.  If pharmacy staff is evaluated by whether they secure prescription refills, regardless of whether the meds are in the patient's best interests, staffers may respond to the incentive to save their jobs rather than the incentive to save patients. The result may be that patients are misled into thinking they should take medication that they not only don't need, but that may be harmful to them. The drug stores should learn from Wells Fargo and change the incentives their employees face.

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