How Chaos at Chain Pharmacies Is Putting Patients at Risk

Pharmacists across the U.S. warn that the push to do more with less has made medication errors more likely. “I am a danger to the public,” one wrote to a regulator.

Comments: 235

  1. The government has mandated limits on medical residents work hours, rules for pilots and rest as well as retirement ages. The chains are exploiting a decentralized governance among all 50 states. All it takes is one state to start the ball rolling: 1. No industry reps on pharmacy boards--advisors nonviting only 2. Mandated breaks 3. Minimum staffing based on RX volumes (like nursing home staffing based on census). 4. Bonuses tied to quality and not just volume 5. No automated refill requests unless a patient asks for it.

  2. I was once given a prescription with a higher dose than what was prescribed, when I questioned the pharmacist, I was told 'just take half the dose, you won't need a refill until later'

  3. Do self-owned pharmacies still exist? Is it possible to avoid these large chain stores in the US? It seems like the public is held hostage by these circumstances.

  4. @Lola In my areas there are two and they are almost twice the price. They are also not on my insurance in-network list. Our two hospitals have outpatient pharmacies but they seem to be overworked too.

  5. They do and many patients would rather work with them. However some insurance plans mandate that prescriptions will only be reimbursed if filled by a CVS. It’s another disturbing trend in our healthcare system.

  6. @Sierra Morgan Thanks for your reply. I guess this is what I meant by being held hostage. You don’t really have a choice anymore.

  7. All you have to do is stand at the counter of a CVS pharmacy in my small city to see what is described in this article. The pace of work is frenetic and unrelenting. I made that observation to a pharmacist who was tasked with giving me a flu shot last fall. His response was diplomatic -- "It makes the time go by fast." Hardly reassuring/

  8. My local CVS is a tragedy waiting to happen. The pharmacy is a mess, it’s dirty, and littered with bags and empty pill bottles, while the short handed staff race around in triple time. There is never a pharmacist available for questions. HIPPA laws are never enforced. I’ve had staff at the drive-up window yell out my name and confirm my medication into the microphone. Customers in line inside pile up right behind you, breathing down your back, not giving you privacy, and the pharmacy does nothing to stop that (setting up a stanchion with a Wait Here sign would be a good start). I always check my meds when I get back in the car. I’m not blaming the people who work there and you couldn’t find someone to complain to anyway. Their job is tough enough. But more and more I go to the small local pharmacy when I need something that can’t be ordered online, with no lines, personal service, and privacy, even though sometimes it will cost me a bit more.

  9. @Frau Greta you are 100% right. I used to work in a CVS pharmacy and they are run very poorly. And you are right, the workers are not to blame, they know it's terrible and are doing the best they can.

  10. Down here in Jacksonville, Florida I watch our pharmacist and her techs at my local Walgreens RUNNING in their space to get it all done. At the same time, I see all the places that have committed to having pharmacies; Walmart, Target, Publix, Costco, the drug stores- they all need more pharmacists and techs. I just don't understand where they can find all the qualified people and how this can safely scale. I guess we have our answer. It can't. I hate to say it because personally, I don't care for the company's business practices, but Amazon's model for fast and accurate home delivery from centralized warehouses seems like the obvious solution.

  11. @Larry : There appears to be no shortage of qualified pharmacists, as the number of pharmacy colleges has expanded. The problem is that these places are unwilling to spend the money on expanding their staff.

  12. @Rose Exactly. Plenty of qualified pharmacists out there jobless! Job placement rates from graduating classes are dropping precipitously and older pharmacists who find themselves having to move for a spouse’s career, etc, can’t find new jobs. If techs weren’t run through the ringer for peanuts and actually paid what they were worth more people would be willing to do the job.

  13. A profit motive in health care. This is the nation we have grown.

  14. You hit the nail on the head. I want my healthcare dollars going to doctors, nurses, pharmacists, x-ray technicians and other direct providers. Not large corporate entities paying their CEOs millions of dollars from the profits off of our healthcare.

  15. @Caveat Emptor welcome to a world where the bulk of healthcare spending goes to pay hospital “administrators.”

  16. Several years ago I received a prescription for thyroid medication in which the dosage was incorrect and might have made me sick or even killed me. However the CVS pharmacist who processed it, caught the mistake and brought it to my attention. He told the doctor to change the prescription to the right dosage. I had to wait a day or two more for the new prescription, but that was the only inconvenience so super Let’s hope all pharmacists continue to exercise the same attention and care to their jobs. But the way things are going these days, who knows?

  17. Umm it’s one thing to cut people and replace with robotics , which is completely possible in pharmaceutical work. But quite another to cut people and replace with nothing but profit for the company. That’s greed and that’s just wrong. They simply need to add robotic Technology to process medication and have one pharmacist to verify. The rest of the workers are low level. Problem solved.

  18. @J Clark "That’s greed and that’s just wrong" That's maximizing profits, which is the goal of corporations like CVS/Walgreen's

  19. I had thought that verifying the Rx, putting pills in a small bottle was the work of pharmacy techs. And with automation, getting the right pill and the right count should by that difficult. The pharmacist is there to supervise the techs and talk to patients. Honestly, I ask my doctor if I have questions and go to the drug manufacturers product info rather than talk to the pharmacist. There are so many drugs and they might only know the 20 most popular. And if we really want to fix the system, we need to fix the insurance companies that mandate where we can go, what quantities, generic, brands, doses, etc. The discount for 3 month supply in my plan is significant.

  20. @Sierra Morgan The pharmacist is a licensed professional. The pharmacist should know about the drugs, how they work, if you are taking other medication which might interact with the new medication, etc. They are not there just to supervise the techs. I ask my pharmacist questions about my medication before I call my doctor. And the drug company product info doesn't tell you everything. I have had side effects from medications that were common but not mention in their info until a few years later. But I go to a stand-alone pharmacy (and it isn't small).

  21. When I use to get my medication from CVS, l would be constantly bombarded by them about refills and 90 day supplies with texts on my phone. NEVER AGAIN!

  22. What about the mail order pharmacies, like Express Scripts, that my United health plan requires me to use for continuing medications? I re order my prescriptions on line. Never see or hear from a pharmacist. I take only two meds that I have taken for years. But I worry about the elderly who may not be in complete control of all the meds they use. After a bad experience in another state, I would never trust CVS pharmacy.

  23. @Judy - I won’t use mail order pharmacies, even though my insurer pushes one all the time, stating only that it MAY even save me a little money. Some of our meds need refrigeration or can’t stand freezing temps but we live in a hot summer/freezing winter area plus our mailbox gets full sun exposure all day. I have mentioned this to my doctors and they have shared that they don’t use mail order for their own meds either!

  24. I have a 4 month old daughter with kidney issues that needs to have a low dose of antibiotics everyday to protect her against infection until she’s old enough and strong enough for surgery. I noticed yesterday that the new refill was off color (it’s a liquid suspension) after about a week of using it. My wife thought it was just a different formulation. I bring it back to CVS and the pharmacist says that they must have forgotten to shake the source bottle it was poured from. No apology, no sense of concern. I point out that they’re using the same source bottle to fill the new prescription. I’m no pharmacist (I’m a food scientist), but I know that there’s two parts to the formula- the powdered medicine, and the flavored liquid carrier. I point out that since they poured my original prescription without shaking it (and who knows how many others), the medicine:carrier ratio is off, which will alter the concentration. The pharmacist became indignant at my suggestion and said it didn’t matter, and sent me on my way. CVS has young pharmacy students filling prescriptions, and there’s often long lines and not enough help behind the counter. Who’s checking their work?

  25. @Ethan Posilkin "Who’s checking their work?" No one.

  26. @Ethan Posilkin Something to consider is to write a snail-mail letter describing these events, addressed to CVS' corporate counsel (registered, with return receipt). Let them know you're aware that pharmacy errors can be the basis for serious lawsuits. Extra points if you can figure out who carries CVS' liability insurance and copy them on the letter. Make it clear that their bottom line could be endangered by preventable errors. A warning of potential liability gets management attention to an extent rarely matched by other means.

  27. If the question we get is from an actual pharmacist, it is usually a good question - such as checking for drug interactions which we are often unaware of (newsflash - patients rarely provide a complete and accurate list of all their medications) or about dosage and frequency. The pharmacist is protecting the patient. But the big pharmacies inundate us with auto-refills, and alternate drug requests. CVS is not only the dispenser, but the plan manager for many patients, and manage the formulary of what will be dispensed as well as dispensing. They auto-reject many drugs requesting the ones that they have a better deal from the manufacturer. The patient will save money, but the drugs are not equivalent. It is a racket, and locally the small pharmacies have very little room to compete successfully. Monopolies are bad for consumers, bad for the economy. But boy, do shareholders love them.

  28. With pharmacies sprouting like poison mushrooms across the nation. With one or two on almost every intersection of towns and cities, it’s no wonder the quality of work is shoddy. My father was a pharmacist who graduated Columbia University in the 1920s and worked in Harlem for 50 years. As a kid and into my early adulthood, I had the world’s best pharmacist, and so did the rest of the neighborhood. As a kid I was a stock boy to a pharmacy in the Bronx on DeKalb Avenue. I saw the relationship between pharmacist and customer. No more.

  29. @David I remember pharmacists like your father, they were counselors to their customers and trust worthy mediators and problem solvers between doctor and patients. Miss those times

  30. As a psychiatrist myself, I and my patients had been baffled by the relentless over-prescribing and over-dispensing by the chains, particularly CVS. Now I get it. My job uses a smallish, non-chain pharmacy for almost all our patients, where we get extremely thoughtful and accurate care. We are true partners in our patients' treatment. As a sometime-patient, I have blocked CVS on my phone and email because of their harassment. It's easier not to be over-prescribed when they can't actually reach you. I also use a neighborhood pharmacy. CVS, like Walmart, has strangled these sort of community-based businesses as best they can in most localities, which I regret, but fortunately, not in my neighborhood. As a citizen, this is so typical of corporate America. CVS is like Amazon, hiring too few people to do too much work and taking no responsibility for the outcome AND tying income to an impossible standard of productivity. This brilliant article highlights why corporate officers must be prevented from serving on public agencies that are supposed to oversee them. We deserve better. Our pharmacists are highly trained professionals who are colleagues in care. They were never meant to be salespeople at the expense of the careful distribution of meds. And make no mistake, PBM's are the managed care of medication, a middleman providing no value whatsoever.

  31. @Ellen Tabor "This brilliant article highlights why corporate officers must be prevented from serving on public agencies that are supposed to oversee them. " This article highlights why corporate officers must be held personally accountable for behavior of their companies and fined/imprisoned as needed.

  32. @Laidback you bet!

  33. @Ellen Tabor I have also blocked all notifications from CVS. Not only were the amount/day staggering, but also too many were clearly generated from an automated system which 1) cannot recognize that the flu shot I got at CVS in October is not an RX that needs to be “taken” every single month 2) cannot seem to recognize that it is too soon for an RX to be refilled, especially when the RX is for a “controlled” drug that would be illegal to be refilled early 3) and on and on. When I initially questioned the local CVS pharmacy about these inaccuracies, their response was to “ignore the notifications” since they (the CVS store itself) didn’t generate them. As a consumer, this is disheartening but as an employee, I can’t imagine how it must feel to have to basically tell your “patients” that your own company’s systems can’t be trusted.

  34. I agree completely with this article. However, it is incomprehensible to me that, as seems to be the case in some instances in this piece, that patients don't take the simple steps of: a) making certain they know what their Dr. is prescribing - and - b) checking the prescription BEFORE they leave the pharmacy to make sure they've received what they're supposed to have received. This would go a long way towards ameliorating some of these errors.

  35. Agreed. I do this as well. I must say that the glut of generics makes it almost impossible sometimes to identify the meds online. Previously you could check the Physicians Desk Reference online or in press for pictures and descriptions. Now nameless, hard-to-trace generics from India and China make verification difficult. I refuse generics when possible. 3$ versus $300 is hard to resist. The pharmacists don’t even know where meds come from “manufactured for..”. Well that another story. Thank you for your comment. We must take the precautions that we can for sure.

  36. @Elisha And, as I have found, not all generics work the same as the brand. Also pharmacies tend to go with the cheapest generic. I pay attention to the number on the pills and know which one works or doesn't. I can ask my pharmacist to fill the prescription with the one that works. My pharmacist will call the distributor for the correct "generic brand." Alas, sometimes the manufacturer no longer makes that medication.

  37. @Raven It's incomprehensible to me that it's incomprehensible to you that everyone out there isn't capable of doing what you describe,

  38. It’s worse in hospitals, especially for-profit hospitals. Nursing staff is stretched so thin that medication errors are one of the primary dangers to life and limb, not the disease or trauma. Consumer beware.

  39. @nurse betty Every hospital is a for-profit hospital

  40. It's a common issue and not just in the US. Britain, Australia and Canada have similar issues and private industry controls the regulatory boards voting to avoid penalties for employers who insist on volume. I was a pharmacist for 22 years and left the industry over this ethical concern. That was 15 years ago, It's worse now.

  41. So why are pharmacists running clinics with unsupervised mid level providers and trying to expand their vaccine business? Why do the pharmacies get the flu vaccine before pediatrician offices do? Why do insurance companies require the same copay from patients going to pharmacies than their doctors offices. Why can employed providers work where profit margins may dictate prescriptions given?

  42. @Wayne : One issue is that pediatric offices can't dispense shots as quickly because you need an appointment. At a pharmacy, you can get a lot of kids vaccinated in a single day. It's also worth noting that some pediatric clinics -- for example, the one that's part of University of Washington Medical Center -- seems to have an aversion to vaccination. We have had the issue that we've been in the pediatric clinic for an appointment during flu shot season and we still couldn't get our school-aged kids vaccinated. We were told it would be too "traumatic" for their first doctor visit. The kids were unfazed. We pushed. Then we were told that they were "rationing" them for higher-needs kids. Seriously? These kids were going to be around an immuno-compromised person. Clinic didn't care. Our kids left unvaccinated. Thankfully, we ended up finding an independent pharmacy that vaccinated kids. Most of the chains don't start giving vaccines until the kids are 14.

  43. @Wayne Because of money and the lobbying power of multi-billion dollar corporations such as CVS

  44. @Rose For most vaccines, CVS doesn't have the records and know the proper vaccines to give. For the flu vaccine, the pharmacies can't come close to the offices in efficiency. For most vaccines, the ideal place is in the pediatrician offices along with appointments. Most pediatricians follow the AAP guidelines for immunization. There are some that don't and they provide service to people who don't want vaccines The pharmacies fragment care for children. While they can be useful, they just scratch the surface. The financial power of these companies are providing a lower quality because the decisions are made by corporate people.

  45. My doctor’s office refuses to fill prescription refill requests from the pharmacy. I was perfectly happy to get a 30-day supply of medications from the pharmacy at our grocery store. Our insurance company stopped paying unless we got 90 day refills at CVS for our “convenience.” Any time I have to call the pharmacy, I wait on hold at least 15 minutes. And a wait of 10 minutes to pick up a prescription is the minimum. I’m being forced to change a blood pressure drug and use an older drug with more side effects if I want the plan to pay for it. I’m not interested in mail order prescriptions. I want a local pharmacy with all my medications. Oh, and the medication that would solve a chronic health issue - costs $1200 a month and is simply not covered. “We’re not telling you you can’t take it. We just won’t pay for it.” The end result is the same, though. Part of the problem is that the company I work for with about 600 US employees is a “self-payer” and so is directly incented to make us cut out health spending. Employers shouldn’t be responsible for employees’ health. Nurses at insurance companies shouldn’t be making decisions about what treatments and medications you can have. Medical professionals shouldn’t be treated like assembly line workers, with time limits and quotas. Having a visit with a sick person is not the same as putting a microwave together. We need a single payer, nonprofit healthcare system. Now.

  46. Good points but solution is to put the power of the law behind all these companies?

  47. @Wayne Yah, right. Likely that will happen w/ the current government administration. (NOT)

  48. @JM My insurance uses a different online pharmacy that also requires 90 day supplies of all but two of my meds. After a rough start, the four I get this way work like clockwork. However, they also demanded I stop taking one of the two pills they can't fill. My doctor sent them a strongly worded letter about practicing medicine without a license and they have backed off.

  49. Just stand back ten feet from your pharmacy counter and watch chaos in action, an exercise in inefficiency. To cover the counter service, people in line, cars at the drive-window, flu shots, drug information, etc., etc., etc., there is one person in addition to the pharmacist. Three times I have gone to pick up prescriptions that the online system has notified me via text are ready only to find they have not yet been prepared. I consider the blame to be the drug store chains in cahoots with the insurance companies that run our lives and to whom we pay top dollar. Give me back a written script that I can take to my small local drug store with a pharmacist I have known for years, who tells me about every prescription I am picking up.

  50. You literally can have a prescription sent to any pharmacy you want. You can go to a good pharmacy and have them transfer any remaining refills out of the chain pharmacy. Consumers have some say in where they go. Vote with your business. Boycott the chains.

  51. I’m probably going to be scolded for this comment, but here goes anyway. In the interest of convenience we have forgotten personal responsibility. As a senior with a chronic condition I take four medications. My old independent pharmacy made several dispensing errors requiring a return to get the correct meds. That’s inconvenient, but less onerous than taking the wrong medication. I’ve changed over to a chain pharmacy. They too have made errors,but now while I’m still at the counter I remove the container from the bag, verify the medication and dosage from the label and remove the pill from the bottle. Does it look like the correct pill...yes, good. If it doesn’t I question the pharmacist. This holds up the line sometimes. But it’s my health not the pharmacy’s quotas that are important to me. I recognize that not everyone can do this, but those who can might consider it.

  52. That's self-defense, not personal responsibility. The pharmacy has the sole responsibility to do its job properly. You're wise not to assume that it will, but we can't let them start trying to shift their responsibility to patients.

  53. @Sheila Warner : I'm not sure why you think that those who are capable of this are *not* already doing it. Also, if you read the article and the comments, what comes out is that some of these pills look almost identical, so your level of diligence wouldn't help if your bottle has the right label but the wrong pills! The real responsibility falls on the pharmacies. And it starts with providing sufficient staffing and adequate breaks.

  54. I tried to find a corporate phone number for CVS to tell them about my concerns with the pharmacy operation. Never did find it. I now go to a local pharmacy, privately owned. Thank God for them.

  55. I think you are missing the point. The physician ordered the correct medication. The overworked pharmacists filled an incorrect medication.

  56. Require pharmacies have patients take pictures of everything they pick up at pharmacies.

  57. @Wayne And what exactly is that going to fix?!?

  58. As a Veteran I receive my Rx’s from the VA. My wife via local pharmacy. What a difference! The VA system is driven by patient-focused needs without the friction of all of the obstacles described in this article. When my VA doctor prescribes medication, I’m asked one question..”would you like to pick your meds up today or have them mailed?” If I opt to retrieve them, I go to the on-site pharmacy and have future meds mailed to my house. No forms to complete, no hassle with an insurance company, and no rivaling between the pharmacist and my doctor. All of this is completed via electronically, minimizing errors and misunderstanding. The VA also provides pharmacy consults in those situations when my doctor and I need clarification and/or direction of my med routine. I have spent up to 45 minutes via telephone conference with a pharmacist discussing my meds. Compare my experience with the circus taking place with the likes of CVS, Walgreens, and the private sector in general, and one can see the need to overall our healthcare system and rid our society of the dread of insurance companies in the healthcare system.

  59. I have had Kaiser Permanente for over 30 years, and my experience is much like yours. If I just walk in to get a prescription filled, it might be a 20 minute wait, but if I am visiting my doctor and they prescribe something, they send the request through Kaiser’s system while I am right there in the exam room. By the time we finish and I walk over to the K.P. pharmacy in the medical center, the prescription is often ready to be picked up. Compare that to a close friend who worked as a nurse at a hospital. She had to get her prescriptions filled at a chain pharmacy (CVS) and faced a lot more hassles. When she retired, she joined Kaiser through Medicare and is much happier with their prescription system. We both use an app on our phone to order refills and they are mailed to our homes. And if no refills are available on the prescription, the request the app creates is one that first goes to the prescribing doctor, who approves or denies it, depending on the medical needs. If approved, he sends the response to the pharmacy and they fill and mail it. Both of us are now under Medicare provided by Kaiser. If this is what Medicare for All looks like, I firmly believe that most people would be much happier with it.

  60. @Hugh This can’t possibly be true. Conservatives assure us government does nothing right, has too many regulations and wastes our money. Meanwhile, private enterprise is more efficient and more cost effective. You must be mistaken!

  61. @ASPruyn - We used to use a HMO 30 years ago and enjoyed the relative convenience, but it closed shop. I would consider switching my insurance to Kaiser if it was like the one in Northern California. But the version in the Washington DC area does not have its own hospital and also has to outsource some tests and specialty care. We have lots of great specialists in our area but as far as I know they don’t also work with Kaiser.

  62. This is not a new problem but it is certainly worse. Fifteen years ago I participated in a pharmaceutical industry meeting and sat next to a senior member of the National Association of Chain Drug Stores and described two prescription errors I experienced with a national chain. The advice I received: switch to an independent or supermarket pharmacy with a lower volume of business.

  63. @AG : Such good advice. We've had much better experiences with supermarket pharmacies. They're usually big enough to have better hours and more drug availability compared to the independents -- and small enough to offer more tailored services.

  64. @AG -- I took my mother to a supermarket pharmacy for a flu shot. There was one employee -- the pharmacist. She was an amazing juggler -- preparing my mother's injection and paperwork, handling phone calls, dealing with customer questions at the counter, and oh,yes, filling prescriptions.

  65. Is anyone truly surprised at this dysfunction? Another clear indication that our for-profit health care system is broken.

  66. @Damolo It seems that this also affects Medicare as well, not just for profit portions of the health care system. With an aging population one can expect that sector to have more problems down the road.

  67. I hope that media attention can achieve what customer and pharmacist complaints have been unable to. I was happy with my local CVS until a few years ago. The people who work there are working as hard as they can, and they are still unable to fill all the prescriptions that come in. Management asks customers to complain to CVS Corporate, because they’ve already done everything they can to get more help. Help is not on the way. CVS Corporate is not acting in response to longtime customer complaints either.

  68. Today there are more pharmacists than there are jobs due to a huge increase in the number of pharmacist colleges. That gives leverage to the chains in forcing more demanding working conditions. Can remember a time when there was a pharmacist shortage if conditions were not good quit and get a new job in a week. Stores 10 years ago kept working conditions reasonable and is some cases chains closed because of a lack of pharmacists. Chains put pressure on government to increase pharmacy programs. The number of new pharmacists greatly increased creating an imbalance. Pharmacist need to unionize it certainly helped level the playing field for nurses. No pharmacist wants to hurt anyone!

  69. @Wake Up We tried that 30 years ago. Didn’t work then because pharmacists don’t band together across all chains with one voice. If you unionize just one company they just close it down. You know what will work? Give us single payer or make prescriptions cash only, I prefer the later.

  70. @Wake Up It wasn't government putting pressure for more pharmacists; it was the Colleges and schools that all opened up pharmacy programs because they were highly profitable.

  71. Don’t believe the corporate spin on this. “..staffing carefully set to ensure accurate dispensing.” is not true. They set staffing to ensure maximum profitability. A close family member has worked in a pharmacy for over 20 years. She says that the work environment has never been this bad. For example, when she worked for Target Pharmacy, two people (pharmacist and assistant) processed 90-100 prescriptions per day. Once the pharmacy was sold to CVS, the workload increased dramatically, reaching up to 200 prescriptions per day with the same two people. These two people are emotionally, mentally, and physically exhausted at the end of each day. They have had zero mistakes…so far, which is a testament to their skill and effort. But they both believe that unless something changes, mistakes will be inevitable.

  72. @John I don't think too many people do believe the spin. It's a sign of these companies' total freedom and impunity that their claims are so laughable. Nobody has to believe them, because nobody, other than a legislative branch captured by their money, has the power to force change.

  73. When I get a prescription I always check the tablet or pill on the Internet to see if it is what it is. Unfortunately that can’t be done with a liquid that is decanted into a smaller container. Ultimately capitalism and medical care don’t mix well

  74. I take daily multiple medications for multiple health medical maladies. I have established a rapport and relationships with all of my pharmacists and their assistants by regularly going inside to get my prescriptions filled and asking questions. Instead of going through the drive through. They tell me if the pills are generic substitutes or have a different color or shape. I also read and reread the disclosures that explain side effects. And contact my primary care physician first if I experience any of them.

  75. We use CVS and I am bombarded with unwanted automated texts and calls to refill prescriptions I don’t want or need refilled. Several times I have refilled what I thought was a 1-month supply only to arrive at the pharmacy to find a 3-month supply at 3x the cost. When I unsubscribed from the 3 month refill texts they took me out of the system that lets me know if ANY prescription is ready. Their website has been difficult to track meds on and won’t locate my information when I search for scripts. Unfortunately employers make a deal with a pharmacy rep and employees are stuck using a pharmacy they don’t want to use. If it were up to me I would never have left Walgreens and would have “voted with my feet” the first time a 3-month supply was forced on me. I asked why they gave it to me and was told my doctor had ordered it, which I now know was a lie. When I asked to change it back to 1-month they told me it would be a 30-minute wait so I just agreed. Customer satisfaction doesn’t seem to be a metric they care about anymore.

  76. @Dee Same here -- I refuse to let them text or call me. And they make me confirm that EVERY time I pick up a scrip. Now I know why they are so insistent.

  77. I was twice given the wrong medication, once at CVS and a second time at an independent pharmacy. I reported both incidents but not much action resulted because while taking the wrong medication was quite unpleasant, it didn't kill me. An aside is that the local pharmacist who tried to cover up the mistake is now doing time for Medicare fraud. CVS also has some serious inventory issues.

  78. None of any of this surprises me. Having had the character building experience of working for an American owned run here in Australia, all that mattered ever was the bottom line. Slash costs to the bone, set unrealistic targets, measure everything and sell, sell, sell. And that was with them having to adhere to our labour laws. God help actual Americans working in that system without half the protections we have. I love the US, but I sure as heck would never work there. Ever.

  79. CVS is the Wells Fargo of pharmacies. Its revenue-obsessed culture exploit customers, but instead of stealing their money like Wells, they steal their health.

  80. I stopped using CVS after witnessing the chaos behind the counter time after time. The pharmacists were clearly over-worked as they multi-tasked by being on the phone, administering flu shots, and filling orders. And when picking up a prescription, it felt like you were a widget on an assembly line with rude employees asking for your birth date. It's the greedy CVS executives who are to blame for enforcing such poor working conditions that have resulted in these malpractice errors.

  81. @MSS Most CVS stores I've been in are utterly disgusting, dirty, and/or cluttered too.

  82. I got a chuckle out of the advice to ask a pharmacist a question about your prescription. In my local CVS, pharmacists work in an enclosed area behind the customer counter. If you want actually to speak to a pharmacist, you go to a separate Consultation window. If you insist, a pharmacist will come around and talk with you face to face. Otherwise, you shout your business to him from fifteen feet away while he's in the middle of filling a prescription.

  83. Why are all these people complaining about the chain pharmacies? Just stop going to them, there are still private ones out there, not blowing my horn when I say that's all I use ever, (shout out to Grove Pharmacy) not only for safety but out of caring for the "little guys". We can contribute to making America great if we abandon the pharmaceutical, real estate gobbling, shoehorned, cookie cutter pharmacies and find the ones that will actually care about your needs. Give up a little convenience and breath a little easier!

  84. @David Shaw : Sometimes they are all that's in your community. Sometimes people lack a car and the chains are all that are relatively accessible. Sometimes you end up with a prescription from urgent care during off hours and the chains are all that's opened. Sometimes the independents can dispense the relatively rare meds you need. Also, if you haven't been through it, you may not know that, for some meds, it can be hard to get meds at smaller pharmacies if you need something very specific: say, the lowest dose of a medication and also in the brand name because the patient has had a bad reaction to the generic.

  85. @David Shaw : Sometimes they are all that's in your community. Sometimes people lack a car and the chains are all that are relatively accessible. Sometimes you end up with a prescription from urgent care during off hours and the chains are all that's opened. Sometimes your insurance doesn't cover the independent pharmacy in your area. Sometimes the independents can dispense the relatively rare meds you need. Also, if you haven't been through it, you may not know that, for some meds, it can be hard to get meds at smaller pharmacies if you need something very specific: say, the lowest dose of a medication and also in the brand name because the patient has had a bad reaction to the generic.

  86. @David Shaw The two independent pharmacies my family used were dropped from CVS' Caremark network, leaving us little choice. There are no other in-network pharmacies within a 30 minute drive. Vertical integration is systematically eliminating choice.

  87. It seems like pharmacists spend a lot of time repackaging pills. I’ve always wondered if that is really necessary. Why not have prepackaged 10 packs from the manufacturer that just get labeled for the patient

  88. For years I seen cvs and the other big chains systematically drive independent pharmacies out if their PBM networks and, because that prevents us from using them, out of business. Now that they've decimated potential competition, long lines and poor customer service are routine. They just don't care

  89. CVS was out of the drug we were looking for, so we went to the local independent pharmacy. I was not surprised by the much kinder service. I was surprised by the cost, less than at CVS. Unrelated, Rite Aid (not CVS!) once switched labels for our daughter, ear drops for eye drops and vice versa; it seems to me that we need to make double checking the prescriptions with google as much an automatic reflex as attaching our seatbelts.

  90. My neighborhood mom and pop pharmacy lost its lease, so for convenience I chose one of the two mega chains within walking distance of home. The pharmacy appears to be well staffed with friendly folks, but the company could hire more employees if it eliminated 8 foot long paper receipts that accompany every single purchase. Buy a greeting card, waste a ream of receipt paper.

  91. @Linda -- yep, and the coupons on that receipt expire in less than a week, typically, so I have almost never been able to use one.

  92. We had a really bad experience with a chain. I'm not sure if it was before or after RiteAid was purchased by Walgreen. We had to pick up a prescription for our kid. Their policy was that you had to sign for the prescription and pay for it before you could *see* the prescription. Once we were handed the prescription, we realized it was wrong. We needed the brand for our kid, as he'd had a bad reaction to the generic. We told the pharmacist at drop-off that we needed the brand. Pharmacist confirmed it was fine. After we complained while still at the counter at pickup, we were told our new pediatrician had forgotten to write the note that says "dispense brand only". First problem: Pharmacist really didn't pay attention to us at drop-off. It should've been easy enough to tell us they need the "dispense on brand" note on the script. Second problem: You can't look at the prescription to make sure it's right before you sign and pay. We got stuck with a bill for almost $150 for a medication we could not use.

  93. @Rose you should fight that. as long as you don't leave the store with the medication they have to take it back. if you need the brand name the doctor has to have it written on it.

  94. @jennifer t. schultz : They literally refused to take it back even though we were still at the counter when the error was discovered. We had already signed and paid, because the chains require you to do that. We asked the pharmacists at drop-off if the prescription was for brand only and he said yes. Yes, the doctor didn't write it out exactly right (new pediatrician, because there is HUGE turnover in the pediatric world as well). But we *asked* the pharmacist to confirm before we filled and the pharmacist gave us wrong info, likely because he was overworked. I think the problem is that you can't expect patients and caregivers to know as much as someone with a Pharm D degree. The prescription written was for the brand. The lay person who has yet to have a bad experience doesn't know there's an additional note the doctor needs to include on the script.

  95. Why don't US pharmacies use the drugs' original packaging and labels like they do in most of Europe---instead of counting out pills into little bottles, or re-labeling drops and creams? It seems way more efficient, and there is so much less room for error.

  96. Many bottles come with 100 tablets in them. If the doctor writes for 30 tablets, the bottle must be opened to fill the order. Most pharmacies label the stock bottle, if its quantity matches what was prescribed. I agree with your sentiment, though. I imagine the EU has greater control over the suppliers or has regulations in place to influence bottle quantities.

  97. @Kurt Dodson In the EU they come in blister packs of 20-30 pills or so. In most countries it is impossible to buy a giant sized 100 pill bottle of ibuprofen, for example. You can get a box of blister packs and that is it. And only in a pharmacy---not a supermarket.

  98. @S.B.S Because that creates JOBS ... and paperwork which requires more people to complete all along the chain, and thus creates more JOBS.

  99. I don't understand why the medications cannot be given in original bottle in which they come. Why does the pharmacist have to open the bottle and portion it every time, why the extra work?? Most of the countries in the world give medication in the bottles it comes from the manufacturers. It is so much easier and less probable for human errors. I guess the pharmaceutical industry and insurance companies make money off of portioning and refilling prescriptions, even for daily medications that need not be refilled. Too much power given to pharmaceuticals and insurance companies with regards to publics health.

  100. @Sats they don't put it in the original bottle because the bottle they take it out of probably has hundreds of pills in it. so they have to count out the pills. if they gave meds out in the original bottle they would not have enough room for the pharmacy.

  101. @Sats the usual reason is the option isn't there, with a few different routes: bottles for 30/90 tablets can literally be too small for the label to fit, oftentimes common medications come in bulk 500/1000 count bottles, and most frequently it's because they come in 100 count bottles with insurance refusing to cover anything beyond that sacred 90-day supply. When the option exists to save time and use the manufacturer packaging the pharmacy certainly takes it

  102. Several years ago, my wife was getting her blood pressure medicine from a chain pharmacy. One morning I couldn't wake her. I called 911 and the medics quickly determined that her blood sugar was dangerously low (about 20 mg/ml) even though she had no history of diabetes and had not been prescribed any medicine to lower her sugar. The medics took her to the local ER, where they stabilized her bood sugar and sent her home. That evening, while we were watching TV, the same thing happened. This time she was admitted to the hospital where they did extensive drug testing. It took two weeks to determine that she had taken glypiside (sp?), a drug given to diabetics to quickly lower their blood sugar. In my wife's case it had caused a life-threatening lowering. Later we realized that her generic blood pressure pills were nearly indistinguishable in appearance from glypiside pills. The only explanation that made sense was that the pharmacy had confused the two pills. Of course when we raised our suspicions with the pharmacist, he refused to consider the possibility of error. Nevertheless, we immediately switched to a local pharmacy and have had no issues since.

  103. Uh, there are plenty of jobs where people don’t have time to go to the bathroom/eat or have breaks. I don’t expect to have a break for 10 hours or so when I work. I’ve been doing this for a decade, and I’m fine.

  104. It is not healthy to not hydrate, eat , or empty your bladder for ten hours on a regular basis. Blood sugars drop, bladder infections from not emptying your bladder, dehydration all effect the cognitive process, cardiac health. The normalIzing not meeting basic human needs over extended periods of time in workplace environments only benefits corporate interests.

  105. That may be the case, but does the work you are doing involve literal life and death of a human if an error were to occur? Nuclear sub operators and pilots have mandatory rest breaks, why do you think that is? It is for safety of the public.

  106. @Laura : Maybe we need two separate sets of jobs and healthcare setups. One can be for people who don't believe workers need breaks and should work for 10 hours straight without food, a bathroom break, etc. The other is for people who believe workers should get regular breaks because it's the right thing to do -- and because workers who are tired, thirsty, hungry, desperately in need of a toilet, and mentally overworked just aren't as productive or accurate. Personally, I know which world I want to live in -- and which medical professionals I want helping me.

  107. I use a local cvs linked to my insurance. Have had no mistakes yet, but the constant texting and calling for refill requests I don't need or want is very annoying and prone to mistakes. I can see how someone stressed or not paying close attention would get things they don't need. The cvs I use seems relatively well run and calm, but I have no way of knowing how many mistakes it makes. My takeaway from this excellent article: check your prescriptions and be familiar with what your pills look like.

  108. This week I picked up a prescription for electrolytes for my mother who was recently started on a diuretic for congestive heart failure. The prescription hadn't been filled because Walgreens was contacting the doctor's office or insurance (not sure which) in an attempt to make it a 90-day prescription. This practice is new but they said it was "in her record" to ask for 90 days before dispensing the prescription. I asked them to turn it off and they did. I had to wait for the prescription to be filled. BE AWARE and BEWARE!

  109. Our beloved independent neighborhood pharmacy closed last year after more than 75 years of service to our community. The pharmacists and clerks were always available for consultation and questions and everyone knew my name. All phone calls were answered by the clerks, who would answer questions and transfer you to a pharmacist if needed. After it closed, all of the prescriptions and a few of the pharmacists moved to a nearby CVS. I now see my pharmacists behind the plastic barrier, heads down. They answer their own phones while filling prescriptions. A computerized voice reminds them of phone calls on hold. The whole scene seems barely controlled. I asked one of them, who now looks constantly frazzled, how it was going. He said they now handled twice the # of prescriptions with the same staff as before. It feels like a train wreck about to happen - not only for the patients, but also for the pharmacists who must work under these conditions. Like others who have commented, I take a few meds which at times I have only been able to get through CVS. No one could tell me why.

  110. @Elizabeth Same thing happened where I live in Minnesota. We had great local pharmacies, but then CVS or another chain forced them out of business. Now the pharmacies are hectic, miserable places where the phones are constantly ringing and the pharmacists look harrassed and overworked, and seem to leave after a few months. I've had to block my local CVS phone number because they called me so often with "friendly" reminders to refill prescriptions I didn't need.

  111. The American system seems silly compared to other countries where I lived. There you get a prescription and they hand you a box. In the USA they actually count individual pills. If you must do it that way then let a machine do that.

  112. Consumers are partly to blame for this. 1. Do you really need a drive through? Why don’t you get out of your car. It will free up the pharmacist’s time and allow him/her to focus on tasks at hand which are considerable. 2. Ask your insurance company why they are not covering your prescription. It is not your pharmacist’s role to procure authorization and have them tied up on phone for 1/2 hour or more 3. Look at your pill bottle to ensure the name and dose are right and open the bottle before you leave to make sure they are the same pills you have been taking. Google images has a repository of pill images for cross reference 4. Be pleasant and civil. Pharmacists are more likely to make mistakes when under duress 5. Do not wait the last moment to have your medications filled. Shortages occur routinely and the pharmacists cannot manufacture medications on the spot.

  113. @Zendr google wont have many of the newer drugs to show pics of the medicine. and how many elderly know or even have a computer to look up the medicine. as I said looking for pics of the pills may not be available with each prescription that is there and actually it is the job of the pharmacist to make sure that the medication given to you is yours. it has to be the pharmacist that will say this medication is a different color etc. also they use pharma techs way too much.

  114. @Zendr : #3 is a great idea but at least some of the chains won't let you look at the prescription until you have already signed and paid. And then, depending on the type of error, they may or may not let you give back for the right thing, even if you have never left the counter -- or their presence -- with the prescription.

  115. @Zendr Regarding your first point, I am disabled with multiple sclerosis; not having to get out of the car to enter the pharmacy is very helpful for me due to my mobility issues. It allows me to save energy for other tasks throughout the day.

  116. It's time for more medicines in blister packs. How many pills are small white ovals? Medications in blister packs come with identification from the manufacturer, and that information is available to the customer/patient every time he takes a pill. How can you tell one loose white pill from the other, often unable to read the embossed codes on one side or other of the pill. It's time for blister packs as much of the world had, for even aspirin and other over the counter drugs.

  117. @Joseph blister packs just adds more paper and plastic to land fills. plus they used to put blister packs. far as OTC again more trash in landfills. we don't need blister packs. we need these businesses to hire more people. they got a huge tax break from trump. do it the right way.

  118. My all purpose rule for taking meds is less is more. I never visit my doctor without asking whether I can safely cut down on them or go off some entirely. Sometimes he says yes.

  119. One way to protect yourself is to keep repeating the words « speak to pharmacist » when the automated answering robot continues asking how it can help you. Ignore suggestions for automated refills. Ignore requests for your prescription number. Every time it asks a question, repeat « speak to pharmacist ». Eventually you will be connected to the pharmacist or to a technician.

  120. Simple. Stop the pharmaceutical industry form giving us bogus drugs. Cannot though since it is now part of the economy. Just like the military industrial complex. So patriotic.

  121. It does seem that our country is gripped by a “Greed Crisis“. No matter how rich these individuals and corporations become they seem to always be looking to make someone work a little harder for a little less money and for less protection. The recent Boeing aircraft debacle is another example of this destructive process. Big business cannot and will not self regulate. We need a strong and moral government to combat this runaway greed. 

  122. Jut another example of the breakdown of our capitalism. Money at all and any costs. Shareholder value. Profit profit profit and who cares about a job well-done, let alone safety.

  123. I'm a psychiatrist, and I've also noticed the push from pharmacies (or rather insurance companies) to get patients on 90 day drug supplies instead of 30. Some insurances even penalize the patients financially if they don't. Others require that people get their now-90 days medications from mail-order pharmacies after only 1-2 months on a drug. That can lead to significant delays in the receipt of those medications if there are delays in the mail, not to mention an incredibly unsafe number of unnecessary pills in the house if I end up changing the dose or the medication. The "45,000 percent increase" in pharmacy fees in the last 10 years, if true, is beyond obscene. I don't know how the pharmaceutical industry has managed to avoid the same transparency we expect from food, manufacturing, and other industries. I know, I know, 'lobbying groups', industry influence on politics, blah blah. But seriously, this can be stopped. The electronic health records are incontrovertible: here is what was sent to the pharmacy, here is what was received by them, and here is what was dispensed to the patients. Any mistakes in that chain of documentation can point to what needs the most work. As for a patient getting the right medication bag with the wrong medications inside? That's when they need to talk to a lawyer.

  124. As a patient who has to schlepp to the pharmacy for every refill, I appreciate the 90-day supply of my birth control.

  125. @Liz : I find that it varies from insurance company to insurance company, often in ways that seem designed to frustrate the patient. I started a new medication and after just one month was told I needed to do the 90-day supply. It was an issue because my doctor and I were still fine-tuning dose and delivery system. At one point, I ended up effectively paying for meds I didn't need because I got a three-month supply and then I had to change what I was getting. But once we settled on the specifics, the 90-day setup was a godsend -- until I got new insurance and they said I could only do a 30-day supply at a time. Stated reason was that it was a waste when people filled prescriptions that they didn't actually *need* 90 days of! None of it seems based on patient needs, but what some bean counter says is going to be best for profits.

  126. @Liz As an ex-pharma executive, I can tell you that it is naive in the extreme to think that the pharmaceutical industry can be required to display the transparency you mention.

  127. Dr. Deming, a leader in quality theory, preached, and his theories still preach, to eliminate goals and quotas as they do not contribute to quality. Businesses should also measure the costs related to poor quality that is a direct result of numerical goals and quotas. Once upon a time I worked for a company that had a time-standard for completing a quality inspection task. I would continuously be berated for taking too much time. My response was “do you want the task completed correctly or within the time standard?”. The chain pharmacies have painted themselves into a corner, however, those chains in many states are protected from poor quality. And we the public pay the costs related to poor quality.

  128. And people think socialism is bad. Any system taken too excess is corrupt. Time to pull back on capitalism.

  129. This is now typical of the American workforce as a whole--pushed and pushed to be "more productive." Just like Charlie Chaplin in Modern Times.

  130. My new local CVS in semi-rural PA has its pharmacy in the back of the store. On one side is the walk up counter, on the other side, the back wall of the store, is the drive-thru window. The pharmacist stands on a raised platform in the middle of the space like a captain on the bridge of a fighting ship. Assistants rush about trying to serve customers, phones ring constantly. Bag upon bag of filled prescriptions are piled up all around. It is indeed a kind of chaos and it has been designed into the facility. It's obvious that the employees are rushed off their feet. No wonder they often wear looks of stress and discomfort. I don't understand how anyone there understands what they are doing.

  131. My long-term mail-order Rx provider used to enforce the 'No refill before ...' date. No longer: now, I can refill immediately if I want. To coin a phrase: "money makes the world go round."

  132. @Grant Refill policies really should be more nuanced- being able to refill too quickly can put people at suicide risk in danger or enable those abusing or selling medication. But a strict no refill before combined with the practice be exactly when that 30/90 day supply should run out can make it hard if you manage to drop your tiny pill on the carpet and can't find it etc. I've even run into times when it appeared that the medication was being under counted either by a person or by being so small they could fall into the machine since everything had been taken appropriately and I still ran out early

  133. I once was given sleep medication from a chain pharmacy where the instructions said to take in the morning. I didn’t make a big deal about it but called the pharmacist to let her know. I work in corporate industry and metrics for tracking people’s efficiency seem to be everywhere. I wouldn’t be surprised if Boeing uses such metrics to track their engineers. Maybe shopping your local mom and pop family pharmacy is a better idea.

  134. Good idea, but insurance companies often dictate which pharmacies they cover.

  135. CVS has an opt out of constant texts and calls. Just did it last week and the harassment has stopped. Not easy to find on the website, but it's there. I'm sure the other chains have this too.

  136. @To MaToo The mechanism to do this generally just means blocking any texts and calls from CVS regardless of reason. The only long term solution is to use a different (and hopefully independent, mom and pop) pharmacy.

  137. It's almost always a chaotic scene in my local Rite-Aid. When I asked the tech why it was always so understaffed, she told me no one wants a tech job there. I asked this 50-something woman if she would mind telling me what she earned an hour. She said she didn't mind at all - $7.50 an hour, and that she'd been there a couple of years. Whole Foods, about a mile away from the store, starts its cashiers and stock people at $15 an hour.

  138. Chaotic is a perfect way to describe my local CVS. Last week, the tech was literally running back and forth between customers, trying to service the 8 or 10 people who were waiting, while others were finding prescriptions for people and servicing the drive through. They should not have to work under these conditions.

  139. @dga yes, the pharmacists make like $120k or more a year, which they deserve, but many of the techs make about $8 an hour. Even our local convenience store starts workers off at $10 so no one stays at CVS for long.

  140. As someone pointed out, it's also nurses and others at hospitals. I recently fell and was lying immobile in our local hospital for three days. When I got up on the 4th day, a DVT that had formed in my leg moved up to my lungs and almost killed me. When asked how this happened, I was told that I had been prescribed a prophylactic anti-coagulant while lying in bed and I had refused to take it!! Turns out it was prescribed, but never offered or administered.

  141. @JerseyGirl The way it was reported is the worst thing- someone was clearly marking a 'refusal' whenever they failed to give the drug to you

  142. @Leah Or after it was apparent that I hadn’t been given any anti-coagulant treatment of any kind (pharmaceutical or mechanical) somebody went back into the record and tried to make it my fault.

  143. No mention of Express Scripts which has annual revenue of over $100 billions. By centralizing the delivery of prescriptions by mail order at lower prices, they have substantially reduced the revenue sources for these other brick and mortar pharmacies. Even Costco which used to have a quite busy pharmacy counter is much less busy now. While Publix is included in the list of mistakes, I find them to be better staffed at all times.

  144. Under-staffing makes pharmacy chains more money, so they all do it because making more money is the only value in corporate America. Under-staffing is visible everywhere, and it comes from squeezing even more out of workers without paying them a penny more. If they complain or don't like it, they're told they can leave. Waiting much longer in line, or on the phone is now the rule of the land, and the time that wastes you is on you, not on rich corporations. Politicians don't deliver many fixes for anything anymore because they, too, are ruled by Citizens United, which makes big. anonymous private money the central force in American politics. Not democracy. Pharmacy chains are not unique in being under stockholders' pressure to produce ever higher returns on investment. The entire United States is organized this way. oz.

  145. @oz. Yep and to your point -- health insurers work the same way. Regular errors that a magically always in their favor. Leave you on the phone, deflect and delay and hoe your give up. Then provide you with a meaningless customer service survey that ranks the individual call center employee rather than the system.

  146. An important article on a serious problem. My personal experience is that CVS constantly does automatic refills even though I've made no request for them. Then I'm bombarded with text messages and/or phone calls asking me to come pick up the drugs. This is pharmaceutical malpractice on an industrial scale, along with all the other issues this article mentions. The power of corporate lobbyists and the sheer size of the dominant suppliers of prescription drugs means that the public interest goes largely unprotected.

  147. @billsett if it is true that CVS is the largest pharmacy, then they must have the most customers. Therefore, it could be possible for those customers to make the most noise! We the consumers should be able to make a statement and demand safety in our care and treatment just by our sheer numbers. Lets not allow these errors to go unnoticed!

  148. @billsett yes, and techs are forced to cold call our patients all weekend bugging them to get a refill they didn't request. We had to get so many "yes" responses or we'd get in trouble. CVS tries to call this a service but it annoys 90% of the patients we call.

  149. An important point is that not every state board of pharmacy requires pharmacists to report their dispensing errors. New York does not require reporting; in fact reporting would likely result in punishment under under the Professional Misconduct Law (Ed. Law, section 6509(2). This creates the perverse and dysfunctional incentive to hide errors. We cannot learn from our errors if we hide them. New York is a classic 'blame and shame' jurisdiction. Step up New York, let's amend this wrong-headed law and encourage process improvement. Thank you for reading.

  150. I highly recommend Capsule pharmacy and their app for those in NY. It seems that not having a storefront may save them a lot of money. Scheduled delivery is on time, super convenient. Been using them for over a year now, I’m very satisfied.

  151. This is going on at every level of healthcare delivery from doctors down. It has become all about corporate profits. Caseloads are expanding as has the need to satisfy many masters(insurance, electronic health records, etc). This inevitably leads to a degradation of patient care.

  152. A large part of the problem are the pharmaceutical industry, who run commercials for drugs to fix problems we did not know we had, and doctors who prescribe them. That is not too mention the kids who are being prescribed various drugs to calm them down (aka control). The reality is that there are very few long term medicines that anyone should take: heart, blood pressure, and seizures are three.

  153. @JimH Another issue seldom discussed: Half the prescriptions in any pharmacy would disappear if consumers would eat right, exercise, lose weight, get enough sleep and meditate. Water and an apple is an example of a natural laxative. Sticking with 1,500 mg of sodium a day plus weight loss might end the need for some heart medications.

  154. In Europe I see medication dispensed in prepackaged packets that even have a day counter to help patients keep track of their intake. When I see our CVS pharmacists counting pills I question why we are behind the Europeans? The answer has to be that there is more profit in buying gallons of my Atenelol blood pressure medication and counting out 90 days (thankfully not 30). I cringed when I picked up multiple meds for an elderly neighbor recently and watched the rush to fill multiple orders. I wondered “what if they make a mistake”. Other than using this space to vent, I have no faith anything will change. Come to think of it, as I write this, I see that this is my sadness: I no longer believe that corporations or the government care about improving our quality of life unless it meets the desired return on investment.

  155. As a pharmacist for 30 plus years I had one stint in a pharmacy that is located in a big grocery store chain. There was a 15 minute clock on the wall as a wait time metric for each prescription. I voiced my concerns to the higher ups that if I needed to clarify something with the prescriber I would not put a metric before patient safety. The clock came down but I jumped at the first chance to get back to hospital pharmacy. Now, even working as an emergency room pharmacist present at code situations my stress level is lower.

  156. Regarding CVS’s pharmacy staffing, this is clearly upper management’s cost-cutting decision. They don’t want to pay pharmacy technicians let alone pharmacists, who require more than the minimum wage cashiers command. They don’t even want to pay cashiers- this is the chain which pushes self-checkout- allegedly to lower prices for customers. Yet if you compare prices, item after item, all the CVS card and coupons and sales do is “lower prices” to be more in line with grocery store and even Target prices.

  157. I changed from using CVS because every time I went there a new person served me. I was just anonymous customer. I found a local small pharmacy, where I am on first name terms with the pharmacists. They double check everything, fill prescriptions and refills while I wait and take a personal interest. Support your local businesses! It's not just in their interest - it's in yours too.

  158. "CVS Health ranks eighth on the Fortune 500 list and has nearly 10,000 pharmacies across the United States." This is about all you need to know. Profits $$$ before people. These pharmacy chains should be required by law to have dedicated office admins handling administrative duties, not pharmacists. I receive all of my medical care through the VA, including medications. The latter comes via USPS with zero trips to a chain store. No complaints here.

  159. In December I switched from CVS to an independent drugstore that thankfully is a preferred provider in my drug plan. This was after CVS made over 5 mistakes in a month in filling prescriptions with the wrong dosage, filling a medication that I didn’t renew and delivering it to my home, getting 2 medications submitted by my doctor but somehow losing one of them in their system even though my doctors office had proof they accepted it electronically and numerous other potentially dangerous mistakes. The only response I would ever get was that there must have been a glitch in the system. I’m so happy I am able to go to a small local pharmacy and will never set foot in a CVS or Duane Reade again

  160. Pharmacists have had my sympathies for years. My local chain pharmacy is jammed, jammed, jammed with white packages awaiting pickup. It always makes me wonder if the pharmacist tosses and turns all night, reviewing the day's workload. Any support these fine people can be given would be cheered by me, a consumer.

  161. @HotGumption As the husband of a pharmacist, they absolutely do lose sleep over it. She is constantly being hounded on for failing to meet impossible metrics while being understaffed (which they know). Part of the issue with understaffing is the fact that pharmacy technician wages start below that of a fast food or convenience store employee, yet they are expected to carefully handle potentially dangerous medications. The whole system is a mess.

  162. @HotGumption As a former pharmacy tech, I can tell you that follows you home. You fill and count and label and stand there while people scream at you in your dreams, just like on the job. You remember random half-finished tasks from the time you leave until you walk back in the door. It’s incredibly stressful, and is steadily getting worse.

  163. If you can, go to an independent pharmacy.

  164. I’m a doctor and this article is an important warning to patients. Frustrated with the regularity of errors (especially failure to discontinue old prescriptions when meds were changed and continuing to fill expired prescriptions), I walked over and introduced myself to the pharmacy manager at the pharmacy closest to my office. He knows I send all my prescriptions there, that I make extra efforts to ensure we all get it right, but I will formally report grievous errors to the state regulatory board. I send the ‘script electronically as required but for anything complex or with patients who might need extra help, I also type detailed instruction for patients, send typed instructions for the patient to give the pharmacy or call the pharmacist whenever doing so seems prudent. This has worked out so much better than having my ‘scripts filled all over town. My “solutions” all take extra time which is exactly what our brilliant “healthcare efficiency consultants” are trying to eliminate (so they can squeeze another patient into our day.) If patients want to use another pharmacy, they can arrange to have the ‘script transferred, but that’s their risk. If they have to use mail order pharmacies, we warn them to be very careful and come to us with any concerns. I don’t remember having these problems when I started practicing decades ago and my patients brought my handwritten ‘scripts to mom & pop pharmacies.

  165. While I applaud your effort, heynineteen, you are surely aware that most of your patients have no control over their pharmacy coverage. To say that they have their prescriptions transferred "at their risk" is clueless at best and arrogant at worst, since they may be looking at paying out-of-pocket at your pharmacy if choice.

  166. @hey nineteen this also speaks to the fact that we need to start operating more as a health care team on the outpatient side of care. Pharmacists have so much additional knowledge to share with patients, but without access to medical records or diagnosis it is difficult to catch clinical errors. Couple this with the metrics imposed by corporations that have absolutely no interest in patient care and it is an absolute disaster. The other commenter is also correct- many health plans mandate CVS or Walgreens as exclusive fill sites b/c it ensures their PBM's make the most money-

  167. @hey nineteen : As a teen, I worked part-time alongside my father, a pharmacist, in the small pharmacy that he and my mother owned from about 1950 through 1988 (and which had been a pharmacy owned by another human before that). He taught me how to read scripts, and then I (as his tech) pulled the med from the shelf; counted the pills and placed them in the vial; and lined up each almost-completed Rx so he could check every element and type the label. Two sets of eyes, always. Always. (A few other employees also were trained to serve as techs.) But that was mostly during pre-Reagan Murka, before profit-above-all-else took over and distorted/destroyed life.

  168. I have used an independent pharmacy in my community for the last 20 years for exactly the reasons discussed in this article. When my oldest was a baby, I went to the CVS a few times to fill prescriptions for him, and was horrified at the long lines and lack of personalized service. Even back then, I felt like there could easily be mistakes made because the staff was too overloaded to pay enough attention. As it turned out, my kids have had somewhat complex medical needs, so using the independent pharmacy, staffed by two pharmacists who know us, and know my kids health needs, has been very helpful.

  169. @techgirl you’re lucky you have that choice. My health insurance requires me to use CVS.

  170. @techgirl I also use an independent pharmacy in my neighborhood in northern Manhattan where they know me. But they and I are keeping our fingers crossed that they will be able to stay open when so many enterprises have been closed by insanely high rents. Another long time independent pharmacy not far away had to close. Walgreen's tried to move into this area but the residents objected and demonstrated and discouraged that, in order to save both our pharmacy and our independent grocery market.

  171. @techgirl I also use an independent pharmacy in my neighborhood in northern Manhattan where they know me. But they and I are keeping our fingers crossed that they will be able to stay open when so many enterprises have been closed by insanely high rents. Another long time independent pharmacy not far away had to close. Walgreen's tried to move into this area but the residents objected and demonstrated and discouraged that, in order to save both our pharmacy and our independent grocery market.

  172. In my experience, numerous prescribers advised NOT reading pharmacy printouts, “because patients who read the side effects just worry that they have them and they probably don’t.” Psychiatrists were (and presumably still are) some of the worst offenders, believing that their patients have tendencies towards “psychosomatic” symptoms, as well as being irrational and worrying too much.

  173. I know several pharmacists at chain stores and all complain of long hours, low staff numbers and fatique. CVS used to require 2 pharmacists to be on duty at all times but cut that down to one pharmacist, working 12 hour days with no breaks. The pharmacists have to fill prescriptions while talking with patients in the store and on the phone and consulting with other medical professionals. But hey - CVS is making money & that's all that matters in the U.S. isn't it?

  174. @June Pharmacist have become Autonotoms in white lab coats. Next time you fill a prescription just look at their faces, it's always seems to be someone in chronic stress.

  175. @June If pharmacies are breaking the law in states that mandate at least two pharmacists to be on duty, then why on earth aren't states shutting them down? It's very simple: "We'll let you resume business when you have appropriate staff." Easy. It's called enforcing the law.

  176. @June My pharmacy recently started closing from 1pm to 2 pm for lunch!

  177. The pharmacy in my neighborhood recently went from Rite Aid to Walgreens, and getting prescriptions filled has been a nightmare ever since. The pharmacists and techs are the same lovely people as before but Walgreens' system does not allow them to provide the same level of service. A friend, a pharmacist tech, went to work at a different location during the changeover from Rite Aid to Walgreens and said it was badly mismanaged. I'm guessing cost-cutting has a lot to do with it.

  178. @Flora We had the same experience here, our Rite Aid pharmacy we'd used for 25 years bought out and switched over to Walgreens. Right off the bat, Walgreens gave me the wrong dosage of a blood pressure medication, which luckily I noticed before I started taking it. Never having a problem with Rite Aid, it did not occur to me to examine the pill bottle at the counter in the store before buying it. Now when Walgreens calls with an automated message that I can pick up meds, I call them back and first verify the type and dosage of meds they have filled. I'm sorry it creates another phone call for them, but I'm not taking a chance on another mistake.

  179. Thank you for this important article. I'm a Florida state employee and my insurance mandates that I fill prescriptions at CVS, so I have no choice but to deal with that company's corporate harassment. Three times this week I've received texts encouraging me to allow them to contact my doctor to refill prescriptions that I'm no longer using. They also try to get me to refill prescriptions when I still have plenty of the medication. My doctor is furious, because they contact her without my permission and waste the time of her and her staff. I have tried twice to be removed from their "updates" but the company policy defaults to put me back into the system.

  180. @Debra I experienced the same thing when the company I worked for went to them for prescriptions coverage. Hated dealing with them. How they get away with such sleazy practices is beyond me.

  181. This is terrifying. We as consumers need to demand these corporations hire more people to do the job right and provide the services we need. But it may be a good idea to search for the drug you are prescribed on the internet and see if the photo and description matches with your Rx. There is also a description of the pill on the Rx bottle and paper work.

  182. @PP - Some insurance companies insist that pharmacists replace a brand name drug with the generic knock-off because it costs less and sometimes the pill doesn’t look the same. The pharmacist should be able to explain this if you ask - unless they are too busy with other expanded duties demanded by head office.

  183. @MJM, and of course there are people on multiple medications, or who are really sick in that moment of time and just want to get home and in bed, so they glance at the bottle. And elderly folks who don't want to 'bother' anyone and aren't internet saavy enough to look up the pill prescription. Everything I take currently is in a generic version. In the past year, out of 6 different medications, I've had 4 change manufacturers, so the pill looks different from the month before. In one case,it was the same manufacturer, but the shade of the pill changed. With all of the different medications out there, I find myself wondering where the PHARMACISTS have the time to check and make sure that last month's manufacturer's pill is indeed a direct match for this month's one. If it's overwhelming to a consumer, what must it be like for providers?

  184. @PP boycott CVS and Walgreens until they fix this problem! If you have the means financially to pay a little more, please for God's sake go to an independent pharmacy - you can make a difference!

  185. Reading this article reminded me so much of hospital nursing, where nurses are short staffed, resulting in compromised patient care and burnout. This short-staffing also contributes to cases of injury and death of healthcare staff when working with irrate, disoriented, or acutely ill mental health patients. Similar to this pharmacy piece, there are no state or federal law to track these injuries and deaths. Hospitals often dissuade healthcare staff from reporting or, in worse cases, retaliate against staff who attempt to urge change to improve conditions. We need to get profit out of healthcare.

  186. @Vanessa The burnout scenario you describe is alive and well. My wife works as a cardiac NP at a high name recognition facility in SE Minnesota, and it’s exactly as you describe. Plus throw in a heavy dose of middle school mentality management and supervision and wallah, you have the potential for disaster.

  187. @Vanessa in calif a there is a nurse to pt ratio law so you cant have so many pts. as far as I know calif is the only state that has that. nurses on floor nursing are constantly leaving the profession. I worked in the OR since you can only do one case at a time. The OR is the money maker in hospitals. the only real money maker. I found out that the OR is no different than floor nursing. the main scheduling desk is constantly on your behind to hurry with each case to get the next one in. it is like an assembly line.

  188. @Vanessa just left a similar comment, also noting that you’ll never see an article like this in the NYT about the nursing profession. Capitalism at its finest, folks. I have worked in the system over 10 years and can assure you, it is all about the bottom line.

  189. As to be expected when we have out of control, unregulated capitalism; health care is more about profit than health or care.

  190. @Lleone Maybe you don't like Bernie/ Warren but this is what they are talking about. Die the health care industry doesn't care, its all about the money and CEO pay. Half of our pills are made in China, so what is going to happen with this virus and imports?

  191. @Lleone you can blame capitalism all you want, but the biggest problem in this instance is the pharmacy benefit managers reaping ungodly profits while providing no discernable service except being a middleman. If we can regulate them, we can get a downstream effect to improve working conditions within retail pharmacies by getting better profit margin on prescriptions. Until then, please I beg of you, go to an independent pharmacy if you are blessed to have the means to pay just a little bit more. You won't regret it, and you'll save your health.

  192. @CVS_Kills 'you can blame capitalism all you want, but the biggest problem in this instance is the pharmacy benefit managers reaping ungodly profits while providing no discernable service except being a middleman.'.......Guess what, that biggest problem you cite IS unregulated capitalism!!!

  193. Yes, behemoths like CVS has expanded in to vaccines, minute clinics and other services but were barely making it doing regular pharmacy services. They should focus on eliminating medication errors and doing their primary job better before trying to take control of the healthcare market.

  194. @EPMD CVS also took control of the healthcare market by refusing to sell cigarettes.

  195. @EPMD I originally thought the same as you until I saw the number of people coming in (especially for flu shots). Many people we see don’t have a primary care doctor or cannot afford doctor visits. Overall I think we are improving herd immunity by increasing the number of available immunizers and also increasing public awareness.

  196. @TechX, I agree - I think that adding vaccines is a good idea and is encouraging people to get them. What truly needs to stop is having any type of a quota for medication. Period. Out of refills? Then you need to call your doctor's office. Yes, offer a 90 day supply if it's prescribed, but don't push it on a patient. Same with automatic refills. Don't even get me started on synchronized refills (all of your prescriptions will be available at the same time each month!). I tried it - couldn't tell what prescription was running out when, and turns out that the poor pharmacist couldn't either - they had to go by what the computer told them. Pharmacies should be doing two things - filling prescriptions, and offering immunizations. No cold calls, no quotas. Just making sure the correct medications go out, interactions are checked and someone is available to talk to patients and doctors as needed.

  197. Many people won't even accept a prescription from their doctor until they have researched what it is for, and determined that it is a fully evidence-based solution to their fully-proven problem. Doing that first basically guarantees that one will not be handed the wrong drug by the pharmacist.

  198. Only in terms of transcription, not in tens of dispensing. Pharmacists are not robots.

  199. @Sequel all the things you mention are smart. However, none of them guarantee that the pharmacy will not make a dispensing error. You can research drug X and discuss it with your doctor and determine that it is needed for your condition. The pharmacy can dispense a drug in a bottle labeled “drug X” but it might actually contain drug Y. In this case, neither the patient nor the doctor is at fault. Unless the patient knows what the pill should look like (can be difficult with generics) and the pill inside looks radically different then she will probably take the pills. If the medication is a liquid that’s not in its original bottle then there might be no way to know unless there are undesired side effects.

  200. @Sequel that may be true in affluent areas where people are also highly educated, but is certainly not the case in the majority of America. There are rural areas, elderly people, non-English speakers, migrant workers, and so many more people who blindly pick up whatever medicine the doctor dispensed for them, without even knowing if they need it or what it is for. Pharmacists do their best to counsel but sometimes cannot speak an immigrant’s language or get through the confusion of an elderly person. It’s naive to assume that if people do the research, they will prevent pharmacy errors.

  201. CVS acquired the Aetna prescription insurance division last year. The first thing they did was inform policy holders that they would only have prescription coverage for drugs dispensed by CVS pharmacies. When I pointed out I received a monthly injection at my cancer center, I was told I would have to purchase the drug at a CVS pharmacy and drive it down to the cancer center to be administered. Needless to say I changed my prescription coverage to another insurer.

  202. I just have to say that I have used Walgreens in MInneapolis and St Paul for many years, and they are wonderful. Absolutely no complaints.They are responsive, efficient and very pleasant at every visit.

  203. I would love to use a mom and pop pharmacy, but CVS (a RI-based company) has been buying them up across the state, running them as a CVS for a year or two, and then shutting them down. We lost our beloved local pharmacy in just this way.

  204. Good to see some light on the bad actions of CVS. I am planning to switch pharmacies since they have miscounted pills on 3 occasions. That is in addition to their many routine errors such as failing to fill an Rx.

  205. Has anyone not walked into their local CVS just to see the pharmacy staffed by like 3 people? With a long line in store, and at the drive through? Its just like at at any other retail store, where the customers in line outnumber the employees 5 to 1, but in the pharmacy the potential consequences can be lethal.

  206. I got a text from CVS earlier this week, alerting me to pick up my refill of an arthritis medication, which clearly reads "0 refills" on the label of the current bottle. I was instructed by my physician to come back to her for a follow-up visit once the medication was nearly finished, but apparently CVS thinks they know better than my doctor! I was confused at what I assumed was an error of automation, but now I understand what happened is far more concerning.

  207. I long ago ditched my national chain pharmacy and I have been using a small, local chain for about four or five years. The pharmacy counter is staffed with at least three times as many people as the local Duane Reade.

  208. I was a pharmacy technician at a major chain for several years, and almost every day was rife with chaos, disorganization, and problems. As the article describes, pharmacists are pulled in several directions at once as phones ring, patients ask questions, and cars line up at drive thru. Pill bottles containing potentially lethal doses were frequently strewn around a cluttered counter, and faxes with patient information piled up as harried pharmacists and technicians scrambled to keep up with the mess. Errors were common, but very little was done to improve the situation. To make matters worse, regional managers with zero pharmacy training would arrive and demand to know why this or that corporate metric wasn't higher. It was one of the most stressful and eye-opening experiences I've ever had in the workplace, and I'll certainly never look at pharmacies the same way.

  209. I was given the wrong prescription at our CVS when we lived in Northern Virginia. I have a very common name, and the birthdates were similar (but NOT identical)! The first time it happened, I was concerned, but understood the mistake. The second time it happened, though, I told the pharmacist that I had no choice but to take my business elsewhere. I shudder to think of what else could have been happening there.

  210. I forgot to add that I really enjoyed the consistently excellent service that I received at multiple Target Pharmacy locations...until they were all gobbled up by CVS.

  211. Not mentioned in here is our over-reliance on prescription drugs. The pill mill we are living in means that these kinds of errors will become only more problematic. Doctors readily hand out prescriptions for the latest thing thanks to some “company rep” who was just through his or her office and left behind some complimentary pens or a complimentary trip to the Bahamas. Meanwhile, we need a drug for every blessed thing because of a television ad (with a list of warnings so long, it makes me feel woozy listening to it). Not every ache and pain requires a drug. Diet changes and exercise can help reduce diabetes, arthritis, heart disease, yet we almost always turn to prescription medication. We’ve ignored mergers and acquisitions of pharmacies that means the pharmacist has no relationship with the patient they are serving. Add on short staffing, insurance pressures and other “cost benefits” to ensure that the merged company still makes a lot of money for shareholders and, well, it’s a recipe for disaster. Yes, match up your pills to the actual prescription, but also talk with your doctor to see if there’s an alternative to taking another pill. It may save your life.

  212. Thank you for this important article. Two points come to mind. First, while medicines can be prescribed electronically, they often cannot be discontinued without a call to the pharmacy. Why the EHR vendors haven't fixed this problem is a question I ask frequently but never get an answer. Second, the use of metrics comes from the MBA suits who run the medical-industrial complex. The purpose is always to maximize profit, not to enhance patient safety. It doesn't sound like state pharmacy boards are all that interested in fixing the problem. I am apalled that more pills can be dispensed than are prescribed, especially for psychiatric drugs. I feel for the pharmacists who are under such pressure to produce. The people running these chains should be liable for both civil and criminal penalties for endangering lives this way.

  213. All these corporations have must have a legal license to practice business. Our governments are failing us if they cannot simply tell these companies, fix this or lose your corporate license. Governments are complicit in this by not enforcing existing laws, not regulating, and not holding corporations accountable when these types of conditions exist. We have a federal government that does not represent the people, that refuses to regulate or even fairly tax big businesses, pushing the bill to the rest of us, that cannot even fix our aging infrastructure. We are taxed, and our voices are not heard. Too many state governments do not exercise the power they have to make changes. Asking CVS politely or appealing to its ethics will not work - threaten their profits, and change will be faster than lightening. And thank you, pharmacists, for speaking up!

  214. As usual it’s all about the benjamins. Personally I take three prescriptions daily. When receiving a refill I always check the bottle label, but my PBM which is CVS, can’t seem to send me 90-day refills fast enough. I just went into my account and turned off auto-refill to mitigate this.

  215. This is one of many issues in healthcare. Large pharmacy chains have been allowed to flourish. They have put the mom & pop pharmacies out of business. There is no question that all they care about are profits. Generics are not equivalent to brand name drugs yet few are willing to admit this. And, not all generics are equivalent. The big pharmacy chains will utilize whatever generic brand they can get cheapest to maximize profits. When one is on a drug that requires specific therapeutic levels, changes from one generic to another can be problematic as it can affect the therapeutic level of the drug which may have been achieved with a specific drug, e.g., warfarin. The large pharmacy chains need to be better regulated. Metrics need to be removed from the industry. Unfortunately, metrics seem to dictate how care is given in hospitals and by doctors. Metrics that hospitals and physicians must meet do not always result in better healthcare. Quality should come first rather than length of stay or the number of patients seen in a day or the time it takes to evaluate a patient in the ER. If you want to bring the cost of pharmaceuticals down, the entire world must bear the cost of research and development rather than just the US. Raising the price of brand name pharmaceuticals in other countries throughout the world would allow the pharmaceutical companies to charge less in the US. This would eliminate part of the problem with the pharmaceutical industry in the US.

  216. I stopped using CVS last year because of pricing. I now use the pharmacy in a local grocery chain. Pricing is better. The pace appears to be slower. But from reading this article not enough people are making the switch away, and the big chains continue to predominate. That’s the larger problem with companies like that. They are so huge, so dominant, they no matter what consumers do, they will be unaffected by consumer actions.

  217. Why would the Missouri pharmacy board meet with CVS and Walgreens in private? What do the board, CVS and Walgreens not want the public to hear? Seems like this would fall under a sunshine law requirement.

  218. It’s happened to me at a Walgreens, a mislabeled bottle from a rushed pharmacist. I thought I was dying. I peeled off the exterior label and realized I’d been given the wrong drug. Watching the rush behind the counter at the pharmacy is all it takes to understand how this happens.

  219. I just went through a mess with CVS Caremark mail order. I tried to refill the prescription for my Glaucoma eye drops and they substituted a new generic and then said the generic wasn't on their formulary! So, I was charged $63 for one tiny bottle of the generic. After a very long phone call and a visit to my eye DR's office, I THINK I have solved the problem. (The eye drops are expensive to begin with, but this was ridiculous.) I wonder if I can return the unopened bottle.

  220. This is absolutely amazing and should be at the TOP of the feed for at least a day (Kobe Bryant??). Having decades of experience as a retailer’s spouse I can tell you that our government’s penchant for approving mergers Plus retailers’ backs-against-the-wall, cut-costs staffing levels to the bone or further, caused this all too foreseeable outcome. Corporations do Not care about people. They exist to make money. Don’t confuse the two.

  221. This is why we have never used chain pharmacies and support our local independently-owned pharmacies. Our pharmacists know us when we call and when we walk in. They know what medicines the members of our family are taking and go out of their way to make things work for us - whether it’s finding a rebate coupon or calling the doc for clarification on a new medicine. Chain pharmacies are driven by corporate profit. While my local pharmacy needs to make a profit, they know that what will make that profit for them is their superior customer service and the caring they provide to our community. Just say no to chains.

  222. @Knitter 216 : If only it were as easy as "just say no to chains." Here are some reasons people may go to a chain: 1. Sometimes that's all that's available in your community. Which is not a surprise, since the chains are actively acquiring the independents. 2. Sometimes people lack a car and the chains are all that are relatively accessible. 3. Sometimes you need to fill a prescription from urgent care during off hours and the chains are all that's opened. 4. Sometimes your insurance doesn't cover the independent pharmacy in your area. (Note, for example, how CVS acquired Aetna and then made CVS the ony pharmacy its policyholders could use. 5. Sometimes the independents can't dispense the relatively rare meds you need -- or don't have what you need in the right dose, don't stock the brand (and you can't take the generic), etc. 6. Sometimes patients with mobility, balance, or extreme fatigue issues prefer a drive-thru, which the independents are less likely to have.

  223. @Rose Not to mention that the chains are unfortunately typically more affordable than independent pharmacies and mediation costs are already so high. And hours matter- if a place closes at 5pm, then I might not be able to get there in time to get my medication which increases my chance of missing a day

  224. So our Indy is on a major public transit route and in the middle of a residential area. Open 8-8 Monday to Sat and 8-2 Sunday. Our pharmacy has gone out of their way to get unusual medicines in for us.

  225. Wasn't legally mandated electronic prescribing, like we have in New York, supposed to virtually eliminate medication errors? As part of the 2009 Omnibus Appropriations Act, otherwise known as the $700 billion bailout, an assortment of laws were passed that mandated changes to healthcare which involved more regulations (and employees hired to follow regulations) as well as the adoption of expensive software platforms with both up-front costs and subscription fees. Many of these changes resulted in the closure of small mom and pop pharmacies as well as small private medical practices. The result has been massive erosion of privacy as the personal data of hundreds of millions have been entered into national pharmacy databases, no meaningful improvement in reducing medication errors, and an epidemic of burnout and early retirement among physicians. And with each passing year, as electronic health records accumulate more and more out of date and irrelevant information, the potential for medical errors increases. In addition, we've seen a homogenization of medical care such that second opinions which might result in a missed diagnosis being caught, or a more acceptable treatment being offered, are increasingly not available to the general public because their doctor isn't an individual so much as an employee of a large corporate health care system.

  226. Very well. Here's what to do. With every scrip you get, once home, open it and look at the tables or capsules. Every drug must have a alpha-numeric indicator. If anything looks amiss, go to any of the 'pill identifier' sites on the Web and check what is written on the pill against the database. They also have pill size, shape and color as well to make sure you have the right data inputted. This is your last line of defense. I go to a high volume Wal-Mart and I have noticed the frenzy that they often have to work in. I will now check every scrip. You should too.

  227. Thanks to the NYT for this awesome reporting. Subscription is money well spent.

  228. This article, chillingly, reminds me of what we now know were the origins of the opioid crisis. Corporate greed, incentivising dangerous and unsafe practices, and the now common business practice of metrics ruling business. As an accountant, I always appreciate a company utilizing the numbers to guide their decisions. However, increasingly I have seen, even small businesses, ruled by the micro analytical data that is so easily produced now. It is disturbing to see companies push their employees to constantly improve their numbers, instead of pushing their employees to give the best care for their patients. And a large (8th largest!) company such as CVS, striving for the highest profit margin without regard for their patients or their employees is indeed reminiscent of Purdue Pharma or Johnson and Johnson. Just push the drugs, without regard for the doctor's recommendation, the working condition of the pharmacist, or the end user, the patient. Thank you NYT, for shining this light on these deplorable companies, only caring about their bottom lines. I particularly appreciate the knowledge of the benefit mangers that are, apparently, a goldmine revenue stream for the pharmacy industry. This all is just disgusting. I will search out a small, independent pharmacy for our future pharmaceutical needs.

  229. My local CVS has called, twice, to pester me to renew and sign up for a 90 day supply. Of what should be a one-time only vaccination. Go figure.

  230. I was waiting at my local chain pharmacy and the pharmacist on duty was on the phone with a customer who had questions about her birth control prescription. He was multi-tasking and had her on speakerphone. So, I heard her full name and her issues (which were intimate). Just a warning that these convos aren't necessarily private!

  231. I’m appalled at the environment at my local CVS. The pharmacists look like rats on a treadmill trying to keep up with their work while a loudspeaker blares ONE PHARMACY CALL incessantly. They do their work heroically despite these appalling conditions. I have given up trying to reach them by phone because it takes less time to drive there. And I keep getting text messages to pick up my meds after I’ve gotten them. But this pales in comparison to the horror stories described in this article. Now we can add Big Pharmacy to Big Pharma on the list of what is wrong with our health care system.

  232. Wow....what a scary notion! In France, such errors would hardly happen as meds are dispensed IN THEIR ORIGINAL PACKAGING. There is no counting, transfer of pills into relabeled containers....never understood why the need to count pills and "repackage"....

  233. The same goes for Austria: pharmacist grabs original packaging, done.

  234. CVS cares about patient safety about as much as they care about cutting down trees to make the paper for their ridiculously long receipts. This is yet another result of the disaster that occurs when corporate behemoths, unchecked by the law and under regulated by government, provide essential public services.

  235. What you are reading here is the typical playbook for today’s corporate environment Cut payroll and squeeze those that remain. These companies issue the same platitudes will stuffing their pockets with dollars. Government agencies issue the same whining complaint of inability to control whilst industry officials sit on their boards of governance. This scenario is always the same. Don’t tell us what we know , tell us how it’s going to be fixed