Pharmacists Confirm Pressure From Management To Refill Prescriptions Automatically

Since we began following the stories of CVS pharmacists who appear to have been pressured into automatically refilling customers’ prescriptions, regardless of whether or not a refill has been requested, we’ve received enough e-mails from from both customers and pharmacists at a number of companies who say these are not isolated incidents.

“Most everyone is doing it,” wrote one pharmacist. “You have to go to great extremes to stop it too and the computer will try to start up again the next time someone gets a new script.”

Then there was this note from a former CVS pharmacy tech:

“There absolutely is pressure on the pharmacists and techs alike to fill prescriptions automatically. The auto-refill count is tallied weekly and totaled monthly. Upper management would come down on us pretty hard if the numbers didn’t meet the goal for the month. So we would have to call customers for enrollments in the auto refill program. It was terrible.”

A pharmacy tech who previously worked at a Publix store says that starting in 2009, directives started coming down from on high to the Pharmacy Manager to automatically sign up patients for automated refills if they met certain conditions like –
1. Patient had to have at least 6 months of history with that specific pharmacy.
2. Patient had to have a medication that also met the requirements.
3. Medication had to be a ‘maintenance med’
4. Patient had to fill that med at least 5 times in 6 months.

“Once those requirements were met, I was told to automatically refill those medications,” writes the tech, who said it happened to him about once a week. “This was strictly a numbers game… More than 75% of the meds we automatically filled without the patient’s knowledge were eventually put back to stock. Of course we harassed the patient by calling them multiple times saying their med was ready, which caused so many phone arguments like ‘I didn’t call that sh*t in, stop calling me.”

One pharmacist from an unidentified retail store did write in to defend the practice of auto-refilling patients’ prescriptions.

“This service is presented as a convenience for customers to improve their medication adherence, and there is no pressure for them to take them,” writes the pharmacist. “If they do not want to pick up the medication, we will return them to stock, and they can later tell us when they want them filled, simple as that.”

He also takes issue with allegations that auto-refilling prescriptions is a way to defraud Medicare/Medicaid or insurance companies.

“If the customer asks for refills, and doesn’t pick them up, we credit them back, the claims are reversed, and we aren’t paid,” he write. “If they pick the medications up, we are paid. Fraud would be falsifying records to show that a customer picked up medications when they did not. We gain nothing by doing this, since an angry customer can easily transfer to another pharmacy and take all of their business with them.”

But that might be a naive assumption his part, according to a CVS pharmacist who explains to Consumerist:

ReadyFilling a prescription allows CVS to bill the pharmacy benefit manager the day it refills the prescription. If the patient does NOT pick up the prescription within 14 days, the pharmacy staff reverses the claim for the script and returns the medication to stock. In this 14-day period, the patient has usually been called or texted to remind him/her to pick up their meds at least 3 times. CVS basically has payment for the prescription from the insurance company within 3-4 days of originally filling the claim… so even if the meds are returned to stock after 14 days, the money has been available to CVS for several days. Think of it as being an interest free loan.

When you consider that there are more than 7,000 CVS locations, and millions of customers, the company could stand to make a nice little pile of interest on that money before it repays the insurers.

“And this isn’t just CVS,” writes this pharmacist, who claims that a friend of hers works at a Target where the insurance company is rebilled even after the meds have been restocked, which gives them another two weeks before they have to repay the insurer.

Beyond the money question, auto-refill can also result in huge problems for customers, especially when they fill a prescription at a store other than one they usually visit.

One reader from Pennsylvania had her medication refilled at a CVS in Connecticut while visiting family. She wasn’t asked about and didn’t consent to being placed into the auto-refill program, but weeks later she’s getting robocalls from the CT CVS telling her to pick up her refill, which she obviously could not. The calls continued until she went to her PA store, where she had to have them transfer the prescription back.

Another Consumerist reader says that CVS’ ReadyFill is now a huge pain in the butt because she can no longer use CVS pharmacies. Her new insurance requires her to use an in-network pharmacy and CVS is not part of that network.

And yet, this hasn’t stopped CVS’ system from robocalling her several times a month to remind her of refills she can’t pick up.

She tells Consumerist that before she even finished the switch to her new insurer, she tried to cancel her ReadyFill enrollment, and that she has asked multiple times since for CVS to stop calling her — all to no avail.

“The worst part is that I still have an east coast phone number, but live in California, so their automated system phones me at early morning Eastern time hours,” she writes, adding that because her job requires her to be on-call, she can’t turn her phone off or mute it in case someone needs to reach her. And since CVS calls from multiple numbers, she can’t block the calls. “I’m about at my wits end with them.”

A reader from Washington, D.C., says she forgot to bring her meds on a trip to San Francisco, so she had the prescription filled at CVS in California.

She somehow got enrolled in the ReadyFill program and gets repeated notifications that her refills are ready. But there’s a problem.

“Every time I request a refill online, CVS sends an email saying that the pharmacy was notified and that the medication will be ready at the requested time, but when I go to pick it up, the pharmacists say they never got notification,” she writes. We’re going to guess that if she hopped a plan to SFO, she’d find her prescriptions waiting to be picked up there.

And then where was the Walgreens customer who had been taking one prescription medicine for a few months but stopped taking it after his diagnosis was changed. Yet all the while he was in the hospital, Walgreens continued to text him that those old meds were ready.

After he got out of the hospital, his wife went to pick up his new set of meds at Walgreens, where she was also given several refills of the old drug all at once.

“Apparently they would refill them when the time came up, toss it in the bin and some system would send me a text message,” writes the patient. “Getting them to take all of the medications back was pretty painless, though it makes me wonder how easy it would have been to tamper with them as they didn’t do anything more than open the bags and check the pill counts.”

Finally, there’s the reader whose wife took prescription blood thinners that need to be tightly controlled but which CVS just kept refilling indiscriminately.

“My wife had to go to for blood tests every two weeks and based on the results she would either refill the current script for another two weeks or be given a new dosage,” the husband explains. “Over the course of the six months she ended up with three different scripts all for the same drug, but in differing strengths.

“When we received the first automated call from CVS that there was a script ready for us to pick up, we assumed that it was the new dosage from the last round of tests,” he continues. “It wasn’t. It was a refill for the older, higher dosage that was not the current the amount she needed.”

Thus, every time his wife needed a refill during those six months, she had to be very careful that the meds being handed to her by the pharmacy were for the correct dosage.

Recalls the husband, “There would be times that there would be three scripts waiting for her, in three different dosages, at the same time.”

Of all reader-submitted stories, CVS was by far the most frequently mentioned pharmacy, followed by Walgreens, Target and then Rite-Aid. But we also heard about people being enrolled at auto-refill programs without their consent and independent and small, regional stores. So it’s likely that the volume of complaints received is representative more of the size of the businesses involved.

“This is not something to blame your local CVS pharmacist for,” says one pharmacist about all the problems with auto-refill systems. “This is CORPORATE and this is their CULTURE. CVS gives lip service to ‘pharmaceutical care,’ but the people who care about the patients are the pharmacists and technicians in the store, not anyone in management or corporate. Often the hardest working teams are the least valued.”