CVS Fined for Prescription Errors and Poor Staffing at Pharmacies

[Marzapan]

Ha! Almost the exact same happened to me when I left my overnight position at a 24-hour store. Always getting blamed for problems that occur during the day shift. Forget about cakes and cards - getting out of that dumpster fire was more than good enough for me.

Even one of the front end managers admitted that good overnight pharmacists are hard to come by.

where do you work now?

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[owlegrad]

well they have to blame someone, and since no one works with you, you are an easy target... they aren't going to blame themselves lol

same concept as new hires are always getting the blame even if sometimes it isn't their fault

Same for floaters.

Although I don’t recall being unappreciated when I worked overnights. Then again I BARELY interacted with anyone so who knows.

 

[Marzapan]

But can we really blame the companies though? PBMs are the ones squeezing all the money. Drug stores are business who are there to make profit. They have to meet the bottom-line in order to attract the investors. How do you expect them to react when PBMs are taking away huge portion their potential profit?

Cvs has always had a bad rep but now other companies are also following the suit and I can’t honesty blame them despite my urge to do so.

CVS owns their own PBM so they are part of the problem. This is like the pot calling the kettle black.

Love how this is the typical knee-jerk reaction of retail pharmacists: "Blame the PBMs!"

Look, I know retail pharmacists are looking for an outlet to pin the blame on so they can feel fulfilled, just like how Batman needs his antagonist, Joker, to justify his existence and motivation in life. But the bottom line is that chains are cutting salaries/hours/work conditions BECAUSE THEY CAN (due to the saturation), not because they are running budget deficits due to poor reimbursements. It's as simple as that.

 

[WVUPharm2007]

Love how this is the typical knee-jerk reaction of retail pharmacists: "Blame the PBMs!"

Look, I know retail pharmacists are looking for an outlet to pin the blame on so they can feel fulfilled, just like how Batman needs his antagonist, Joker, to justify his existence and motivation in life. But the bottom line is that chains are cutting salaries/hours/work conditions BECAUSE THEY CAN (due to the saturation), not because they are running budget deficits due to poor reimbursements. It's as simple as that.

The reason we all work for giant corporations is because the PBM ***** are the ones that made owning an independent financially untenable.

 

[Marzapan]

The reason we all work for giant corporations is because the PBM ***** are the ones that made owning an independent financially untenable.

That sounds like an insurance, not PBM, issue. Doctors, dentists and optometrists have all also been seeing massive headwinds if trying to open their own business and are increasingly being forced to take institutional jobs now due to consolidation in the health care industry. There's no "PBM/middleman equivalent" in those sectors.

 

[WVUPharm2007]

That sounds like an insurance, not PBM, issue. Doctors, dentists and optometrists have all also been seeing massive headwinds if trying to open their own business and are increasingly being forced to take institutional jobs now due to consolidation in the health care industry. There's no "PBM/middleman equivalent" in those sectors.

Yeah. PBMs arenn't contributing to the decline of independents. Look at this clown, lol.

 

[Marzapan]

Yeah. PBMs arenn't contributing to the decline of independents. Look at this clown, lol.

And look at this illiterate, lol.

 

[owlegrad]

Pharmacy certainly does have issues besides just PBMs. But to downplay PBMs is laughable. They extract billions of dollars out of healthcare while offering almost nothing. The fact they exist at all is mind-boggling.

 

[VA77]

Saturation is a problem but PBMs are affecting both independents and chains and you ask any community pharmacist that this is the primary problem

 

[WVUPharm2007]

And look at this illiterate, lol.

SOME GUY ACCIDENTALLY HIT A KEY TWICE! MAKE HIM PAY!!!!!1!

 

[Chrish]

Love how this is the typical knee-jerk reaction of retail pharmacists: "Blame the PBMs!"

Look, I know retail pharmacists are looking for an outlet to pin the blame on so they can feel fulfilled, just like how Batman needs his antagonist, Joker, to justify his existence and motivation in life. But the bottom line is that chains are cutting salaries/hours/work conditions BECAUSE THEY CAN (due to the saturation), not because they are running budget deficits due to poor reimbursements. It's as simple as that.

This post is so stupid that I feel dumber after reading it.

 

[Marzapan]

Pharmacy certainly does have issues besides just PBMs. But to downplay PBMs is laughable. They extract billions of dollars out of healthcare while offering almost nothing. The fact they exist at all is mind-boggling.

Saturation is a problem but PBMs are affecting both independents and chains and you ask any community pharmacist that this is the primary problem

SOME GUY ACCIDENTALLY HIT A KEY TWICE! MAKE HIM PAY!!!!!1!

You are all misunderstanding what I'm saying.

PBMs work for insurance companies, not pharmacies. If "reimbursements to pharmacies are low" then the root cause is the negotiated contract between insurer and PBM because the insurer always has the final say in benefit design. Large insurers also always have negotiating power and PBMs will customize their offerings to these clients, so the only scenario where a PBM would have "total control" of reimbursement is if they are deaing with small insurers who don't have the personnel and are therefore picking from standard formulary offerings of the PBM, which affects which drugs will be reimbursed at what rates.

So to say that "PBMs are the root cause of failing reimbursements/independents closing down" is just an uninformed statement. Of course, the majority of pharmacists who post on these subs are retail or hospital pharmacists so I don't expect a high level of intellectual discourse when it comes to the subject of reimbursement besides "PBMs are evil!"

 

[WVUPharm2007]

You are all misunderstanding what I'm saying.

PBMs work for insurance companies, not pharmacies. If "reimbursements to pharmacies are low" then the root cause is the negotiated contract between insurer and PBM because the insurer always has the final say in benefit design. Large insurers also always have negotiating power and PBMs will customize their offerings to these clients, so the only scenario where a PBM would have "total control" of reimbursement is if they are deaing with small insurers who don't have the personnel and are therefore picking from standard formulary offerings of the PBM, which affects which drugs will be reimbursed at what rates.

So to say that "PBMs are the root cause of failing reimbursements/independents closing down" is just an uninformed statement. Of course, the majority of pharmacists who post on these subs are retail or hospital pharmacists so I don't expect a high level of intellectual discourse when it comes to the subject of reimbursement besides "PBMs are evil!"

Why stop there? Wouldn't the REAL villain be peoples' employers? They are the ones that contract the insurance companies that contract the PBMs to manage their employees health plans. The insurance companies are simply providing the service that Rando-employer chose them to manage. If Rando-employer didn't want the cheapest rates and the cheapest plan, rates wouldn't be that low.

And why stop there? It's the patient's fault for working where they work. If they worked somewhere else, they wouldn't have their employer contract with an insurance company that contracts with a PBM that is screwing independent pharmacies.

And why stop there? If the patient's parents didn't have kids, they wouldn't need healthcare from their employer, who contracts the insurance, who contracts the PBM that screws the independent pharmacy.

And why stop there?

*Five hours later*

...and why stop there? If that original amoeba didn't evolve into a multicellular organism...

*Six hours later*
...we arrive at the TRUE culprit. Either the big bang or the deity of your choice that created the universe that created conditions for celestial...

*Eight hours later*
...that contracted the insurance company that contracted the PBM that screws the independent pharmacy!

We need to eliminate God and/or the big bang!

 

[Hels2007]

 

[VA77]

You are all misunderstanding what I'm saying.

PBMs work for insurance companies, not pharmacies. If "reimbursements to pharmacies are low" then the root cause is the negotiated contract between insurer and PBM because the insurer always has the final say in benefit design. Large insurers also always have negotiating power and PBMs will customize their offerings to these clients, so the only scenario where a PBM would have "total control" of reimbursement is if they are deaing with small insurers who don't have the personnel and are therefore picking from standard formulary offerings of the PBM, which affects which drugs will be reimbursed at what rates.

So to say that "PBMs are the root cause of failing reimbursements/independents closing down" is just an uninformed statement. Of course, the majority of pharmacists who post on these subs are retail or hospital pharmacists so I don't expect a high level of intellectual discourse when it comes to the subject of reimbursement besides "PBMs are evil!"

If the root cause is between the insurance company and the PBM then that would be between Aetna and Caremark which are both owned by somebody but I forget who?

 

[Chrish]

You have to account for rampant discount card epidemic too that not only brings down the medication cost, but also charges pharmacy money on each claim for “providing them business”. Gone are the days of an ideal cash paying customer when even 80 year old grannies know about Good rx.

These cards are great for customers but terrible for business. Techs/ rphs who encourage patients to find discount cards are idiots and they shoot themselves in the foot. Unless I feel patient really needs their meds and there is a financial trouble, I would never mention discount card. Let them be naive and pay cash because it would help me keep my job bit longer.

 

[VA77]

You have to account for rampant discount card epidemic too that not only brings down the medication cost, but also charges pharmacy money on each claim for “providing them business”. Gone are the days of an ideal cash paying customer when even 80 year old grannies know about Good rx.

These cards are great for customers but terrible for business. Techs/ rphs who encourage patients to find discount cards are idiots and they shoot themselves in the foot. Unless I feel patient really needs their meds and there is a financial trouble, I would never mention discount card. Let them be naive and pay cash because it would help me keep my job bit longer.

Very true but there is one silver lining and that is less MTMs

 

[WorthlessOxygen]

Pharmacy certainly does have issues besides just PBMs. But to downplay PBMs is laughable. They extract billions of dollars out of healthcare while offering almost nothing. The fact they exist at all is mind-boggling.

From what I've been told, they were pretty appreciated by pharmacies when they first cropped up. They offered an easier way to submit for reimbursement and charged a small fee for the convenience. Now they've grown to the point where they're skimming who knows how much money from the healthcare industry.

Really an industry that pulled itself up by its bootstraps if you think about it.

 

[deleted562805]

That sounds like an insurance, not PBM, issue. Doctors, dentists and optometrists have all also been seeing massive headwinds if trying to open their own business and are increasingly being forced to take institutional jobs now due to consolidation in the health care industry. There's no "PBM/middleman equivalent" in those sectors.

Completely false with respect to Doctors and Dentists and Optometrists. There are middle man at play in those sectors

In medicine, private equity firms have been buying out private practice for quite some time. Some of these firms prefer hiring mid levels, Sound Health is one example. Now Walmart and CVS are starting to cash in on primary care medicine.

In Dentistry, Smiles Direct who is now owned by CVS is the middle man competing with independent dental practices.

And with Optometrists, same as physicians. Private equity firms and retailers like Costco and Sams are competing with independents.

Now these middle man( private equity firms) affect those sectors with respect to hiring and reimbursement.

PBMs affect independent pharmacies mainly due to poor dispensing reimbursement and high DIR fees

 

[Old Timer]

In the dental field, the insurance acts like a PBM. Want a composite filling on back tooth, sorry, only pays for mercury amalgam. Cleanings must be exactly 6 months apart. You want an implant, not covered.... Same BS

 

[Chrish]

That’s the reason dental is moving away to corporate model as well. Independent dental practices will slowly disappear

 

[Hels2007]

The trend is some three centuries old. Started with manufacturing, expanded to food production, then to selling of goods, and now to services.

 

[Old Timer]

Some day we will catch on to what MBA's have done to the our society. Greed will destroy us....

 

[Xenophylia]

If the root cause is between the insurance company and the PBM then that would be between Aetna and Caremark which are both owned by somebody but I forget who?

I'm pretty sure they're both owned by Satan....

 

[mentos]

Overnight at LTC? Didn’t know such jobs existed. How did you get that job? Did you have any prior experience?

How safe do you feel about your job given current climate?

There's plenty of 24 hour, closed door LTC pharmacies. But just like hospitals, there's only two overnight pharmacists so spots rarely open up. A classmate got me in. I had retail experience and a per diem at a hospital before that.

 

[Xenophylia]

I have an overnite LTC job also. We only have one overnighter (me) since we're only 24 hours M-F; pharmacists take call on weekends at night. We were going to do 7 on 7 off but couldn't reach an agreement on hours so that fell through. I got my job through word of mouth- the place was going to start being open 24 hours and wanted someone to do night shift which I was already doing elsewhere. Lots of people are horrified by the idea of working nights but its really not bad. But you just have to be there at the right time when someone is hiring.... I had done 20+ years of retail prior to that.

 

[Xenophylia]

LTC places unfortunately are very rarely stable. The loss of one facility can cause layoffs. I've pretty much come to expect we could close at any time. That's just the way these places work if they're independent. Stable pharmacy jobs these days are about as common as unicorn farts. You just learn not to get too attached to any job as nothing lasts in this profession.

 

[owlegrad]

I don't know if I would enjoy an overnight job that was Mon-Fri every week. The appeal of overnight to me was the 7 on 7 off schedule. Without that it's just a crappy overnight job IMO. You can't even say you have every weekend off since working friday overnight means working Saturday morning. It's good that you like it though, that's all that matters.

If you don't mind me asking what were the proposed hours going to be that you couldn't agree with?

The lack of stability is so true though. Contracts come and go and so do the jobs those contracts pay for.

 

[Chrish]

So folks who have found LTC jobs, is hospital/ LTC experience necessary? Or is it possible to get it with just retail experience?

I have no intention of leaving my current gig but I am not naive enough to believe I am gonna keep it for next 10 years just because I want it..

 

[owlegrad]

So folks who have found LTC jobs, is hospital/ LTC experience necessary? Or is it possible to get it with just retail experience?

I have no intention of leaving my current gig but I am not naive enough to believe I am gonna keep it for next 10 years just because I want it..

We have more ex-retail pharmacists than any other type but we have ex-hospital as well. We also had a new grad with no previous experience. We do not have anyone who worked in LTC prior to us. We also do not have anyone who has done a residency. In every case it was either a matter of knowing someone or just having the attitude that the director was looking for.

 

[Xenophylia]

I like overnight primarily because its just myself and a teach. We get along, and there is no management. No office politics and minimal bull****. It's not hectic and there is plenty of downtime. Casual dress- T shirts and jeans. The people in the am are happy with us because we eliminate all the crap for them to go through in the am and they don't have to be on call. Since we're the only two who want nights, our layoff potential is low. After 20 plus years in retail hell, dealing with pencilneck *sshole management and clueless corporate bigwigs it is a breath of fresh air.

The 7 on 7 nights off failed because the boss wanted us to actually work a full 80 hours. My understanding is usually for that schedule you work 70 and the other 10 is a sort of "differential" for what people consider to be an undesirable shift. Most places work something like 8pm to 6am daily. That adds up to 70 hours and you get paid for 80. That's just (typically) how it's done. The boss couldn't get over the idea that- in his mind- he was giving us something for nothing. It would have actually save him money as he would have no longer had to pay the pharmacists to take call on weekends. But he wanted to cut his nose off to spite his face and the interested parties became quickly uninterested.

I worked LTC/retail combo for an independent when I first got out of school years ago. Also did consulting. It was my favorite rotation in college since it was so laid back. When I got back into it the place that hired me didnt care about lack of experience...they just wanted someone reliable who would work that shift. So I gained experience there and then bailed when they got bought out. That made me more desirable for this job since I had leaned the software and had gotten a "refresher" to how LTC worked. This place had no night shift before so I came in knowing what I could do for them- what had worked and what didn't at the other place I'd worked. Again the job was all word of mouth. Found out about this place through a friend of my wife's who was a nurse at one of the facilities we service. There is something to be said about networking. Most places don't need to advertise the better jobs anymore.

 

[deleted1062534]

Gonna fit those in along with COVID-19 testing and a 30 flu shots

Hahaha my flu goal averages to 55 shots a day and I do 1k rx a week

 

[Old Timer]

Hahaha my flu goal averages to 55 shots a day and I do 1k rx a week

what is your flu goal 6,600?

 

[Sine Cura]

So the answer to these fake goals is... don't meet them?

 

[WVUPharm2007]

what is your flu goal 6,600?

My store's goal was over 3,000. I thought that was ridiculous, but I think I heard that one of the Bustleton stores had a goal higher than that. I wonder what Harbison's goal is. 10,000? lol.

 

[RxPreceptor]

So the answer to these fake goals is... don't meet them?

DM wants us to set up at least 4 clinics...doesn't want to hear that you can't; no details about compensation/payment for efforts. Corporate: do it in your spare time and if you meet BS metric goal, you shall be awarded with 2 extra hours of tech help per week

**** homework...why I can't take DM seriously (treat everyone like children and the unrealistic expectations of course)
Hell, I struggle to simply man pickup let alone production and triage...workstation assignment board: you and one tech man pickup, drive through, triage, QA, phone calls, deliveries, etc. and so help you God if you don't push register prompts about add Rxs, immunization gaps, proactive fills, 90 script set ups, etc...the list just goes on and on...and if you don't meet goals we need you to come up with an action plan and have one on one individual meetings with each employee...blah blah blah, pencil pushing BS to avoid addressing the real issue of understaffing

 

[Wickett]

DM wants us to set up at least 4 clinics...doesn't want to hear that you can't; no details about compensation/payment for efforts. Corporate: do it in your spare time and if you meet BS metric goal, you shall be awarded with 2 extra hours of tech help per week

**** homework...why I can't take DM seriously (treat everyone like children and the unrealistic expectations of course)
Hell, I struggle to simply man pickup let alone production and triage...workstation assignment board: you and one tech man pickup, drive through, triage, QA, phone calls, deliveries, etc. and so help you God if you don't push register prompts about add Rxs, immunization gaps, proactive fills, 90 script set ups, etc...the list just goes on and on...and if you don't meet goals we need you to come up with an action plan and have one on one individual meetings with each employee...blah blah blah, pencil pushing BS to avoid addressing the real issue of understaffing

I get the need to set up flu clinics, but it boggles my mind they expect people to do it unpaid in their spare time. My friend at cvs has a similar mandate and is expected to organize at least 3 of them on her days off unpaid. My company encourages we reach out to businesses about potential flu clinics, but we get paid for our time.

 

[footfairy]

I already know the answer is "because it costs money" but wouldn't the company be better served having a trained salesperson setting up these clinics? I barely know the current iteration of the company policies regarding clinics(seriously, walgreens officially said no clinics under 25 shots, then back peddled, then pivoted to some other criterias, rinse repeat ) and am busy with a hundred other tasks. Plus I literally benefit from NOT setting up clinics as all they do is create more work for me with no positive effect on my life.

A trained, commissioned salesman that has a clear directive would have to be a better choice than me.

 

[ValeRx]

So glad I don't have to worry about BS flu shut clinics and goals anymore.

 

[Xenophylia]

I work overnight at a LTC. I am fortunate to have a unicorn job. It was unexpected and I only got in because I knew someone.

Mentos, just curious. How stable is your employer? Mine is with an indy. They've been "laying off" people (mostly non RPh) like crazy. Everyone here has terrible morale and the higher ups tell us nothing. Kind of feels like you never know if the place will be boarded up when you show up for work. Are all indy providers like this? Our owner has made frequent terrible business decisions, but of course is blaming everything on COVID and reduced rxs simply because it's fashionable to do so. I've heard some others in LTC say similar things. Is this just the way things are now?

I don't want to quit because it's easy and relatively stress free, but really don't think there's a future here. If it only could have lasted a few more years...

 

[Old Timer]

My store's goal was over 3,000. I thought that was ridiculous, but I think I heard that one of the Bustleton stores had a goal higher than that. I wonder what Harbison's goal is. 10,000? lol.

You guys only have to do 25 flu shots per day, every day from September 1 to December 31.

 

[mentos]

Mentos, just curious. How stable is your employer? Mine is with an indy. They've been "laying off" people (mostly non RPh) like crazy. Everyone here has terrible morale and the higher ups tell us nothing. Kind of feels like you never know if the place will be boarded up when you show up for work. Are all indy providers like this? Our owner has made frequent terrible business decisions, but of course is blaming everything on COVID and reduced rxs simply because it's fashionable to do so. I've heard some others in LTC say similar things. Is this just the way things are now?

I don't want to quit because it's easy and relatively stress free, but really don't think there's a future here. If it only could have lasted a few more years...

I don't think any pharmacist job is stable. I think I can be laid off anytime within the next few years.

 

[owlegrad]

Mentos, just curious. How stable is your employer? Mine is with an indy. They've been "laying off" people (mostly non RPh) like crazy. Everyone here has terrible morale and the higher ups tell us nothing. Kind of feels like you never know if the place will be boarded up when you show up for work. Are all indy providers like this? Our owner has made frequent terrible business decisions, but of course is blaming everything on COVID and reduced rxs simply because it's fashionable to do so. I've heard some others in LTC say similar things. Is this just the way things are now?

I don't want to quit because it's easy and relatively stress free, but really don't think there's a future here. If it only could have lasted a few more years...

I realize you directed this at Mentos but I can confirm scripts are WAY down at my LTC job as well. So far we have only laid off techs but morale is how you describe. We had a pharmacist go on leave and another quit so that is probably why no RPh layoffs yet. I expect if things keep up this way they will reduce our hours and lay off more people.

 

[Wickett]

I realize you directed this at Mentos but I can confirm scripts are WAY down at my LTC job as well. So far we have only laid off techs but morale is how you describe. We had a pharmacist go on leave and another quit so that is probably why no RPh layoffs yet. I expect if things keep up this way they will reduce our hours and lay off more people.

Coming from traditional retail and seeing all the financials, we got hit too. The claim that covid would lead to increased business for pharmacies seems to be bunk.. After the wave of 90 days in April, we saw about a 10% drop in our script count and a significant drop in net profit compared to the same time last year. We mainly got hit by some of our regulars switching to mail order, as well as filling a lot less pediatric meds with schools being closed. I had to get rid of any RPh overlap I had and take on a bigger workload to keep my techs' hours intact.

I have friends that got hit way worse, especially in the prison and hospital systems, to the tune of 33%+ drops in scripts and revenue, leading to furloughs, forced pto, paycuts, layoffs etc.

 

[RxPreceptor]

Retail in my area...overall script count has been down across the various chains (yeah, big tech hour cuts...really feel bad for the part timers, some of which quit due to not having enough hours)...I will say as a positive, Rx count has been improving these past 2-3 weeks despite being the middle of the summer (things look to be going back to normal slowly)

 

[Xenophylia]

Yeah I think we're all headed for unemployment here. Part of the problem is when you amass a certain amount of $$$$ as a business owner, a write off is as good as a successful business. The owner has been literally running the place into the ground. I'm just waiting for the facilities we service to start bailing. If we lose one, it's definitely over.... Would probably be better if we were sold, but if it winds up being one of the "chain" LTC providers they'll fire everyone here anyway...

Supposedly there was a meeting between management here today. Probably means more layoffs tomorrow as that has been the procedure for the past few weeks. They already reduced 401k match and have eliminated any overtime. All of the veteran techs have left and they are replacing them with inexperienced kids. Quality of service has definitely suffered. Not moving in a good direction. Kind of early to retire but at my age I'll never get hired anywhere since this area is REALLY bad for age discrimination...I know another RPh who has been going through it and some have straight out told her she's too old (late fifties) despite having 30+ years retail experience.

 

[Chrish]

About 15-20% of our volume was from local emergency room scripts which is down to less than 5% if I were to guess.

People are no longer going to emergency room for stuff like sneezing for 2 days, penis not getting up or having an itch. Shows you how 90% of emergency visits pre-covid were junk.

 

[NorthTexasPharmacist]

Love how this is the typical knee-jerk reaction of retail pharmacists: "Blame the PBMs!"

Look, I know retail pharmacists are looking for an outlet to pin the blame on so they can feel fulfilled, just like how Batman needs his antagonist, Joker, to justify his existence and motivation in life. But the bottom line is that chains are cutting salaries/hours/work conditions BECAUSE THEY CAN (due to the saturation), not because they are running budget deficits due to poor reimbursements. It's as simple as that.

I believe PBMs are ruining pharmacy in general across the nation. Unfair reimbursements and DIRs have been the most pressing issues with PBMs. Here in Texas, Texas Pharmacy Association created a group called Independent Pharmacy Academy to fight back. I believe State of Georgia also is taking similar action. The Arkansas supreme court hearing will hopefully be the end of PBM abuse. As an independent pharmacy pharmacist, I believe that PBMs are the most useless entities not just in pharmacy but in all medical professions.

 

[TheBlaah]

This place had no night shift before so I came in knowing what I could do for them- what had worked and what didn't at the other place I'd worked. Again the job was all word of mouth. Found out about this place through a friend of my wife's who was a nurse at one of the facilities we service. There is something to be said about networking. Most places don't need to advertise the better jobs anymore.

Out of curiosity, what happens when you take a week or two off for PTO? I imagine with no night shift partner and the fact that you filled a new position, it'd be very difficult to find people to cover your shift.

 

[Farmgurl20]

Gonna fit those in along with COVID-19 testing and a 30 flu shots

We have been doing non stop covid testing, plus other vaccines. Can’t imagine what’s it like when flu shots comes in. It’s pure madness already. Also, techs have been calling out left and right so that makes things 10 times worse.