Join Our E-mail List

E-mail

CVS appears to have other priorities for its pharmacists, however. According to the report of an investigation by North Carolina’s WCNC-TV, CVS pays cash bonuses to its pharmacists in the state based on how many prescriptions they fill. And CVS periodically updates pharmacists on their numbers so, in the words of the report, “they can gauge how many thousands of dollars they’ll make if they keep putting pills in bottles at the current rate.” At the CVS pharmacy for which WCNC obtained records, more than 80 percent of pharmacists’ incentive pay came from the number of prescriptions filled. As former CVS pharmacist Josh Rimany told a reporter, “It’s alarming because their priority – they’re telling you – their priority is volume – to make more money and to do more prescriptions.”139 Further, CVS pharmacists say, management has been mandating higher prescription volume targets —from year to year, sometimes even more often – without adding more staff. Time spent with patients does not make the chain’s performance measures.

CVS’s approach to pharmacy has raised regulators’ hackles. The North Carolina Pharmacy Board has repeatedly cited CVS for creating working conditions in which the Board found pharmacists are more likely to make mistakes, according to the WCNC investigation. The station’s analysis of 10 years of pharmacy board records found that CVS has the most citations of any chain for medication errors where the board found the pharmacist was so busy that it increased patients’ risk. And, in Massachusetts, after the Massachusetts Pharmacy Board there substantiated 62 complaints involving medication errors and other problems at CVS in 2006, the company agreed to a settlement that included independent review and oversight of its safety practices for two years.140 The board brought in outside experts from the Institute for Safe Medication Practice to review the way CVS runs its pharmacies, and their experts suggested that CVS’s intensive focus on prescription volume and other statistics might value “speed above safety.” The Pharmacy Board extended the term of CVS’s oversight in 2008 because the chain had not yet implemented all the safety improvements recommended by the Institute’s team.

Despite these warning signs, CVS President and CEO Tom Ryan claims his company can get even more volume out of its pharmacists, telling investors CVS can fill 10 percent to 14 percent more prescriptions than it does now without hiring more pharmacists.  Yet across all U.S. pharmacies, prescription volume rose 12 percent from 2002 to 2006,  and chain pharmacists say they are already overworked and lack enough time to counsel patients on their medications. According to the most recent National Pharmacists Workforce Survey, conducted in 2006:

• Fifty-nine percent of chain pharmacists rate their workload level as "high or excessively high."
  
  
• Fifty-seven percent of chain pharmacists report that their workload has increased or greatly increased compared to a year ago.
  
  
• Close to half of chain pharmacists – 46 percent –personally dispensed more than 160 prescriptions per day in 2004. Nearly a quarter -- 22 percent – dispensed over 200 scripts per day.  The North Carolina Board of Pharmacy has established 150 scripts per day as a safety benchmark for preventing medication errors.
  
  
• Chain pharmacists have said they want to spend almost a third of their time counseling patients but actually spend only 18 percent of their time in patient consultation.  This 18 percent estimate may actually be an overestimate of counseling time at many drug stores: An American Pharmacists Association newsletter mentions the problem of "negligible (or absent) counseling offered in many pharmacies."