Quota System Is Dangerous

       Many of us who work in the community pharmacy practice setting are more than familiar with various quota systems and metrics.  But are these metrics and a focus on numbers creating dangerous situations for patients? 

       A current News 3 story about a former CVS technician raises some questions related to the metrics and quota systems that are commonplace among the larger pharmacy chains.  Is the current push towards volume pressuring stores to experiment with dangerous practices simply to keep the prescriptions flowing quickly?

       According to the news report, a former CVS pharmacy technician in Las Vegas is making some serious allegations against CVS Caremark in an upcoming lawsuit.  The former employee accuses the company of pressuring pharmacists into changing dosing strengths and quantities without the prescriber’s consent.

       The technician also accuses the drugstore chain of instructing store level staff to automatically enrolling all birth control prescriptions into CVS’s auto-refill program without the patient’s consent.  If the allogations are true CVS could be facing serious trouble.

        My first instinct is to wonder if this was an isolated problem or if there is a wide-spread problem at CVS pharmacies.  Did one district manager encourage the changing of dosages and strengths simply to boost their territory’s numbers or is there a broader problem?

       If true, the allegations behind this pending lawsuit demonstrate just how far drugstore chains will push employees to boost their metrics.  The games of speed and volume have replaced accuracy and patient care as primary goals. 

       The culture of numbers over people is simply dangerous and scary.  Pharmacists can’t be expected to meet the demands of our job if we are forced to work in an environment where volume and metrics are the only measuring sticks for success. 

       The existence of quotas, and their influence on store level practices and policies, could create an environment where patients are at risk.  What happens if company policies are in direct conflict to a pharmacist’s ability to complete our jobs?  Who is at fault when these policies result in misfills or harm to patients? 

        To give CVS the benefit of the doubt, maybe this specific story is simply a disgruntled former employee taking out their personal frustrations on CVS?  But what if the allogations are true?  What would that say about the current state of community pharmacy? 

        I would never make assumptions about dosing changes or strengths on a prescription order simply to save time.  Even if an “honest mistake” is made by a prescriber and I can predict with a good amount of certainty what a prescription should have been, I will still call the prescriber to confirm the order.  That is my job as pharmacist!

        Pharmacists must take care not to assume anything with a prescription order.  And any company who even implies that it is OK to change aspects of a prescription without a prescriber’s consent is simply wrong. 

       Metrics aren’t necessarily bad.  But when they become the sole driving force behind policy decisions, patient’s lives are put at risk.  And when quotas are created to pressure pharmacies into meeting those metrics, safety is abandoned in the name of volume. 

        Take note CVS, people are watching.  If what this former technician says is true, you will have a huge problem on your hands.  Hopefully an investigation is forthcoming that will reveal the truth behind these allegations. 

        It’s one thing to encourage the growth of a business through efficiencies and good operating practices.  But to push volume and speed at the expense of safety is simply wrong and dangerous. 

         What do you think?  Could these allegations against CVS be true?  If so is this an isolated incident or is there a widespread problem that needs to be addressed at CVS?  I’m afraid if I found out the answers to these questions I’d be scared for the future of community pharmacy.

The Redheaded Pharmacist

4 Comments to “Quota System Is Dangerous”

  1. By PharmD Blogger, October 29, 2012 @ 11:04 pm

    We need to find a new way make money! Margins are shrinking per prescription filled. Will MTMs take over as our source of income? We need to find something or our nice six figure incomes are going to disappear.

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  2. By Pharmaciststeve, October 30, 2012 @ 12:48 pm

    Anything that I heard about CVS and their “going ons ” I have found 90%+ to be correct. I wish we knew the details .. as to why CVS sent this tech to a hospital for a psych eval. Was this just a tactic to help them discredit the techs claims.

    Techs seem to have more balls than RPH’s .. it was techs that blew the whistle on CVS in Sandford, FL and all the C-II being dispensed… it was techs that blew the whistle on WAGS giving out gift cards for transfer Rx to Medicaid/Medicare/Tricare .. which is ILLEGAL..

    I would bet that anyone had one of these PBM’s contracts evaluated by an attorney… the phrase included in that evaluation “lacks mutuality”… which means it is very one sided.

    As soon as we figure out that we are the foundation of the entire system… we refuse to forgo our primary function(s) accurate filled Rx… good counseling… and whatever metrics can be accomplished with the staffing that is allowed gets done.. and the RPH should be the one who decides which metrics are the important in good patient care and meet the standard of practice.

    After the mess with NECC.. the increased inspection of compounding pharmacies has already increased in a few states.. at least 4 of these pharmacies have been shut down.. and one has suspended operation.

    We all need to expect much more through inspections from the various BOP’s.. this is going to make the BOP’s getting increased budgets from the legislatures a slam dunk.

    IMO.. because of the growing surplus.. the BOP’s will have little incentive to be lenient with RPH’s who screw up.. probation and suspending of licenses will become more common. The corporate employer will continue business as usual.

    if we obey the laws… the employer will have to staff up accordingly… maybe even not renew third party contracts.

    IMO… change is a foot… particularly in the enforcement of the practice act…

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  3. By Crazy RxMan, October 30, 2012 @ 1:02 pm

    I can’t speak for all pharmacies, but I know my pharmacy chain adds everyone to the automatic refill program regardless of the medication. Perhaps it is legal in my state, I don’t know. I’m not understanding why that would be a legal issue anyway, especially for birth control or a maintenance medication. It seems to me that would be useful in helping with patient adherence to taking their medication.

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  4. By Dr. Blog, October 30, 2012 @ 1:04 pm

    I would assume that changing strengths wouldn’t be an issue if the pharmacy is out of a particular strength, for example dispensing two Prednisone 10mg tablets when the prescription says to dispense one 20mg tablet, at least in my state. Tracking down a hospital prescriber in such cases is extremely time consuming and usually not helpful. And when you do get a hold of the prescriber, they act like you’re insane for asking. When they issue an order to the hospital pharmacy they expect it to be changed if necessary.

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