U.S. investigating CVS prescription refills

The average performer, the documents noted, says that "we automatically enroll patients in ReadyFill for maintenance meds. It helps our score."

By CVS' standards, therefore, an average pharmacist automatically refills people's prescriptions regardless of whether they ask for it.

The documents also detail "enhancements" to what CVS calls its Patient Care Queue, a computer system that contains information about every patient and the medications they're taking. The enhancements include "opportunities" to refill outstanding prescriptions.

The system tracks the percentage of patients not on ReadyFill and those who are.

Document: CVS Pharmacy Business Metrics

To be sure, some people may fail to take their medications regularly, and that can have serious healthcare repercussions. CVS and other pharmacies are behaving responsibly when they take the initiative in encouraging compliance with doctors' orders, which might include automatic refills.

But CVS seems to have taken this objective to a different level by creating metrics that measure nearly every activity undertaken by a pharmacist.

A training manual provided to drugstore employees shows that they're graded on everything from an individual store's profits to how long a patient's prescription waits to be picked up. To reach the quota for refills, CVS pharmacists are instructed to call patients at least three times to pick up their medicine.

The documents from the May pharmacists' meeting stated that CVS aims by the first quarter of 2013 to "develop effective strategies for addressing the most common patient objections" to having prescriptions automatically refilled.

The company also intends to "create guidelines for effective motivational communication" when a patient balks at a refill, such as "asking open-ended questions" that discourage one-word answers. Example: How do you feel when you take your medication regularly?

CVS pharmacists said these meticulous "best practices," introduced over the last couple of years, have resulted in a high-pressure environment in which employees feel their jobs depend on meeting company quotas.

"If you do not meet your targets, you face writing action plans to better improve it and write-ups for poor performance," a second California pharmacist told me. "Also, you need to know that if the metrics are not met by your review, you receive a 'needs improvement' and therefore no raise.

"Many pharmacists, including myself, have not seen a raise in two years," the pharmacist said.

A third CVS pharmacist in California said employees share the goal of making sure people take their meds. They'd just prefer a less profit-focused approach.

"Sure, some pharmacists just want to get the scripts done and never speak to a patient, but there are also those who will want to know why a patient isn't taking a certain medication anymore," the pharmacist said.

"Do they have side effects that are bothering them? Are they struggling financially with co-pays? Are they aware that they can use a pill box to help them, especially if they are elderly or have a lot of medications?

"That is the right way to improve compliance, by getting down to the bottom of the problem," the pharmacist said. "Not filling scripts like a factory … and having patients build up stockpiles in their house because they can't get off our calling list."

Complaints can be filed with the California Board of Pharmacy at http://www.pharmacy.ca.gov. State officials said they will coordinate their investigation with federal authorities.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send tips or feedback to david.lazarus@latimes.com.