I Caught CVS Caremark Trying to Scam Me
I recently wrote how local pharmacies have been scamming us with prescriptions that many patients don’t need. They are doing this for money and it has been working. It is unethical and it is putting patients at risk for taking too many drugs or just the wrong meds.
I admit that I was slow on this. I have a small DPC office. My assistant would get the faxes from the pharmacies and just give me tasks on my EMR to refill. And I did. Then I caught a few drugs that I had stopped before. Uh oh.
Now our policy in the office has changed. Interestingly enough, we have received multiple calls from the PBM lowlifes at CVS Caremark. They demanded we refill metformin on a patient. We asked if the patient requested it and they said yes. Their fax reiterated the same. We called the patient and he adamantly denies asking for it. In fact, he has three bottles of it at home.
This has to stop. It should be illegal. Patients are going to get hurt. As if PBMs are not evil enough. Please be aware of this and share this so others may learn from it.
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I bet CVS and other large retail pharmacies have bilked patients and insurance companies for millions of dollars with their automatic refill scams. Maybe a class action lawsuit or whistleblower claim would get their attention. Just saying.
A few days ago, I filled a prescription at a local pharmacy (Rite Aid). The clerk handed me the bottle and said $34 please. Knowing the pills retail for less, I asked about the price.
She explained “you have insurance”.(MVP)
I returned the bottle, transferred the prescription but lied about having health insurance.
Paid $8 and went home with my medication
Is There something wrong with this picture?
We have a policy in our office that prescriptions are refilled only if the patient calls requesting a refill. Never ever just on the basis of a fax from the pharmacy (and CVS is by far the worst offender!)
I get refill requests for discontinued medications, wrong doses of medications, medications for deceased patients, medications for patients I haven’t seen in over a year, medications that were last filled years ago, and medications that clearly shouldn’t be refilled like antibiotics. Pharmacists used to participate in providing good medical care to patients. Now they just seem to want to sell them stuff. Another new ‘trick’ is for the pharmacist to request refills one week after filling the last refill on an old prescription. That way they always have one on file. If you aren’t astute, this is easy to miss because the patients next appointment is still three months away. But you may not realize they just got 90 pills and now you’ve authorized 90 more. Which means you might not see that patient for six months. Even though they were supposed to return in three months. Many patients are under the impression that if they have pills then they don’t need an appointment. In addition the pharmacist harasses us under the guise that the patient wants this prescription and asked for it. You will get multiple requests for the refill. Even after declining the refill—You get two more requests. Almost always a lie. Automatic refills are NOT good for patients. They are good for pharmacies and making money.
My favorite is the major chain which sends a fax or message about a new rx stating the “patient requested a 90 day supply” when it is a new drug and the patient hasn’t done any such thing.
These are the same ethical pharmacies that have increased their prices of surgical masks?
There was a great article yesterday in the NYTimes on how the big pharmacy corporations make life miserable
for pharmacists. Lots of stuff in it as well as how and why the pharmacies interact with physicians.
https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html
The point is to not blame the individual pharmacists, instead blame the MBAs and the JDs and the politicians for how shitty the system is.
Like most of the commentators on this blog over the years that I’ve been reading it, I am disgusted by the behavior of large healthcare companies, i.e. hospital systems, pharmaceuticals, insurance companies . I am a proponent of small businesses such as my three provider primary care practice that doesn’t prioritize profits over patients needs. I think it’s possible to balance those interests to make a good living without gouging the systems and/or patients. However, small business can’t do everything, large scale organizations with their large finances are need for big ticket items such as trauma centers and research etc.
Where I apparently divert from many of those on this blog is my belief that the only way to prevent large corporations from behaving badly is to have the government revamp the way in which the corporations are allowed to operate. I don’t love our government, I dislike many things that they do in many facets of our society, but government is the only authority with the power to reign in corporate abuse. Lawyers, large corporations and government are all part of that ugly category of “necessary evils”. We don’t need any of them to go away, we need them to be more moral. How do make that happen? The only accountability to the greater society happens in the voting booth. Vote for those who you think will be most concerned with the public welfare and not those who are most concerned with the corporate welfare.
‘Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.… ‘- Winston Churchill.
Well said, reasonable sentiments. My problem is that the government has empowered these corporations far more than regulated them, and more often attempts to further regulate paradoxically seem to harm the individual far more that constrain the corporation. Government is certainly no more moral and usually a great deal less intelligent than these rat-bastard corporations; and government is formally accountable only to voters (hi lobbyists) who through their own ignorance, apathy, and emotionalism, are certainly getting the results they deserve. I’ve no optimism at all that this will ever get better.
Is big government taking over healthcare, or is corporate healthcare taking over government?
Hard to tell.
Tell patients and pharmacists you have prescribed enough to last till they need reassessment. No refills without patient call or visit. This notion that you need a doctors signature but don’t need any doctoring is ridiculous.
Remember how Walgreen’s went from a single small drug store to a successful chain:
Waaay back during Prohibition there was a neat loophole in the law prohibiting the manufacture or sale of alcohol: It was still legal for “medicinal purposes.” How is that defined? Well, if a doctor writes a prescription, it’s legal (like medical weed, right?). And who supplies it? Well if it’s a drug, then it’s supplied by a drug store.
So Walgreen’s went from a small business to a big business by circumventing Prohibition on an industrial scale and profited immensely in doing so. I would bet that there is some part of the other chains that got its start the same way. And the oxy craze sure didn’t hurt any of them.
This stuff is in their DNA: Push out as many drugs as possible to make as much money as possible, and the patient, and the community be damned.
Pharmacies are in business to sell pills. What you described is not illegal because CVS and all the pharmacies ask patients “Would you like to sign up for Automatic Refills?” Patients usually say “Yes!” and that covers them. The patient has AUTHORIZED CVS to seek refills without being asked permission to do so ever again. Blank Check!
In the future advise patients to NOT agreee to automatic refills. We don’t have much to remember to check on, read, click on or do all day anyway….