You already knew that our healthcare system is screwy. But you probably didn't know that at least some pharmacists at CVS, the nation's second-largest drugstore chain, were refilling prescriptions and submitting claims to insurers without patients' approval.
The bizarre, possibly illegal practice was spelled out in confidential emails sent this year by a CVS pharmacy supervisor to dozens of pharmacists under his control.
The emails make clear that an internal quota existed for prescription refills, with at least 30% of calls to patients about their medications expected to result in return business. A threat of "major personnel changes" was made to pharmacists who couldn't hit their quota.
"You need to go out and make this happen this week and every week going forward," CVS supervisor Ryan Barna said in one email. He oversees about 50 pharmacists in the New Jersey area.
CVS acknowledges that the emails were legitimate and that prescriptions may have been processed without patients' say-so. But the company says this is an example of an overzealous manager going too far, not a practice followed by CVS pharmacists nationwide.
"It is not our policy to refill prescriptions without a patient's authorization," said Mike DeAngelis, a CVS spokesman.
Never mind that Barna described his instructions to pharmacists in one email as being among CVS' "best practices." And never mind, as I've reported before, that the company has had incidents in California and elsewhere of enrolling people in its automatic-refill program without approval.
A spokesman for the New Jersey Division of Consumer Affairs, which licenses pharmacies, told me that officials will look into whether CVS violated the law by filling prescriptions without patients' OK.
Virginia Herold, executive officer of the California Board of Pharmacy, which licenses pharmacies and pharmacists, said she would have "grave concerns" if claims were being submitted to insurers in this state without patients' knowledge.
CVS pharmacists in California and New Jersey told me that a claim is submitted when the prescription is initially filled and not when the medication is picked up by the patient. This is to ensure that the patient is covered.
Herold said the practice described in the CVS emails could be considered insurance fraud — at least in California — because CVS sought reimbursements for drugs that patients never ordered.
Barna's emails instructed CVS pharmacists to watch for prescriptions for so-called maintenance medications for chronic illnesses that hadn't been refilled on a regular basis. Pharmacists were advised to make at least four attempts to reach the patient by phone.
If the patient couldn't be reached, the pharmacists were told to wait until Friday and then fill the prescription anyway.
Pharmacists were instructed in a February email to tell patients that "we tried calling you several times this week on this past-due prescription" and that "I went ahead and filled it so it would be ready for you."
Barna acknowledged in the same email that "some have expressed concern over this practice." But he said it was no different from other methods used by CVS to help customers take their medication.
Reached by phone, Barna declined to comment on the contents of his emails.
The messages were shared with me by a former company insider after I wrote a recent column about the drugstore chain having enrolled a Seal Beach man in the company's automatic-refill program without his authorization.
DeAngelis, the CVS spokesman, insisted at the time that no quotas exist for enrolling people in the refill program and that pharmacists aren't judged based on their number of refills.
The Barna emails suggest otherwise. He repeatedly emphasized to CVS pharmacists that they have to meet certain benchmarks for refilling prescriptions, or "scripts."
"Remember," Barna said in a February email, "each of you owns scripts and has an obligation to meet your weekly script budget; this is one of the areas you'll be evaluated on come review time."
Pharmacists under Barna's supervision knew to take such warnings seriously. In a March 2011 email, he declared that unsatisfactory performance would cause him to make "major personnel changes in multiple stores."
"Please understand this is not the road I wanted to go down," Barna wrote, "but action plans/phone calls/advice haven't yielded the result we're all looking for & it's time for a change in leadership in certain stores."
CVS' DeAngelis said that Barna's instructions to pharmacists weren't representative of the company's policies. "The messages in the emails in question were not authorized by CVS pharmacy," he said.
DeAngelis said the company's management first learned of the situation from another supervisor, "who recognized that the messages were not in compliance with our pharmacy policies and procedures."
He said CVS has "already addressed this matter" with Barna "and educated the pharmacy teams about our correct policies and procedures." Barna apparently remains a supervisor for the company's drugstores.
DeAngelis declined to specify when the company first became aware of the refill practice.
A spokeswoman for a leading health insurer, who requested anonymity because her company does business with CVS, confirmed that claims are submitted to insurers when prescriptions are filled. Payments can be made at any time over the next few weeks, depending on the insurer's reimbursement cycle.
If a CVS customer failed to pick up the refilled prescription, the medicine typically would be restocked after two weeks and the insurance claim canceled. Any money paid by an insurer presumably would be refunded.
But one consequence of CVS' practice, the insurance spokeswoman said, is that a patient who tried to fill a prescription elsewhere during that time may have found that CVS had already secured reimbursement for the order, thus preventing the patient from dealing with the pharmacy of his or her choosing.
It could also slow a patient's access to medicine until the insurance issue had been addressed.
By CVS' own estimates, people not taking required medication on time results in about $290 billion in annual healthcare costs.
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 firstname.lastname@example.org