Chances are if you work for a larger retail pharmacy chain, your employer has some sort of auto refill service available for your pharmacy customers. But those services are now being investigated under concerns that patients are having prescriptions filled they didn’t want or need.
The idea is simple really. Patients have maintenance medications they need filled on a regular basis. These patients may not want the hassle of having to request a refill for the same prescriptions time after time.
So out of convenience, many large retail pharmacy chains (and some smaller ones) offer some sort of auto refill service. The programs, usually requiring patients to opt-into the service, will automatically refill a maintenance medication for a patient at some set interval.
So what is wrong with such a program? Well there are now concerns that patients are being enrolled in these programs without their consent, prescriptions are being filled that weren’t requested, and there are even questions of potential Medicare fraud related to these services.
The LA Times reported that CVS was investigated earlier this year for filling prescriptions and billing insurance companies for medications without patient approval. Now, questions surrounding other auto refill programs at other large retail pharmacy chains are emerging.
Concerns are being raised that some retail pharmacy chains may have quota systems in place to put pressure on store level pharmacists to enroll as many patients as possible. And while the companies have publicly denied it, pharmacists are reporting that their compensation may be at least partly tied to meeting these goals or quotas.
The result is that patients may be enrolled in such programs without their consent. And this could lead to prescriptions being filled for patients that weren’t needed in the first place.
Have these drugstore chains become too aggressive with their auto refill programs? Are these companies at risk of committing insurance fraud by billing for un-necessary prescription claims? These are questions federal and several state investigators are now looking to find answers.
I will say that my company, like several others, does in fact track auto refill percentages and there is pressure placed on pharmacists to boost auto refill enrollment numbers. And because auto refill programs are commonplace now, I could see where it would be a focal point for management teams at several large retail pharmacy chains.
I don’t personally have a problem with auto refill programs as long as it is a program patients must opt in and the chains don’t use enrollment numbers for performance comparisons. Unfortunately, some chains apparently have used auto refill program enrollment numbers for the basis of evaluating, ranking, and rewarding stores and employees.
I’m glad there are investigations into auto refill programs. The problem is what can investigators do? A fine doesn’t seem to faze the larger pharmacy chains. What will fining a company the size of CVS really do to curb behavior or change corporate culture? It would have to be a meaningful amount relative to the company’s earnings to even have a chance to be effective.
I’m glad this story is getting out to the masses because it demonstrates the pressure large pharmacy chains place on meeting metric goals. As pharmacies are pushed toward meeting goals such as higher auto refill percentages, what is lost is the need to maintain filling accuracy and prevent needless mistakes.
Does your employer put pressure on store level staff to boost auto refill enrollment? Is there any level of bonus or compensation that is tied to meeting a quota or enrollment level? Do patients get enrolled without their consent? I’m afraid too many of us would answer yes to those questions.
The Redheaded Pharmacist