CVS customers say prescription refills weren’t OKd

George Engelke manages his CVS prescriptions online. If he needs more of a medicine, he orders it. If he’s going to be away from his Corona del Mar home, he tells the pharmacy where to send the shipment.

He’s never asked CVS to automatically refill his prescriptions.

Engelke, 76, recently returned from a vacation in Montana, where he had CVS send a single order of his glaucoma medication and syringes for insulin injections. He got a call from the drugstore the other day informing him that they’d taken the liberty of sending another batch of supplies to the Montana address.

“I never asked them to do that,” Engelke told me. “I already have enough meds to last me another month. On top of that, now I’m going to have to figure out how I’m going to get these new meds from Montana.”

An honest mistake on CVS’ part? Engelke doesn’t think so.

“It seems like a blatant attempt to sell more medicine and charge the insurance company for it,” he said.

I heard similar complaints from dozens of CVS customers in California and elsewhere after reporting last week about confidential emails from a CVS supervisor in New Jersey instructing pharmacists there to refill prescriptions and submit claims to insurers without people’s approval.

CVS acknowledged the legitimacy of the emails but said the unauthorized refills were limited to about 50 East Coast pharmacists and that the supervisor involved wasn’t following company policy.

In response to the latest comments from customers nationwide, CVS spokesman Mike DeAngelis said the company is “continually looking for ways to make it easier for customers to take their medications as intended by their doctors.”

He said company policy “specifically directs pharmacists that they should obtain patient approval” prior to filling prescriptions.

“It is not our policy to refill prescriptions without a patient’s authorization,” DeAngelis said.

How then to explain the numerous Californians who say they too have had prescriptions refilled by the company without their say-so?

Joyce Rangen, 63, of Sherman Oaks, takes a handful of medications for her osteoporosis, but not all of them all the time. Some are used only when needed. When a particular medication is in short supply, she calls in a refill order to her local CVS branch.

“Three or four times,” she said, “I’ve gone into the store to pick up one prescription and they’ll hand me others as well. I tell them I didn’t order the other medicines, and they say that they refilled them anyway.”

My column last week featured emails sent by CVS pharmacy supervisor Ryan Barna to dozens of pharmacists. The emails were made available to me by a former company insider.

The pharmacists were instructed to watch for prescriptions for so-called maintenance medications that hadn’t been refilled on a regular basis. They were advised to make at least four attempts to reach the patient by phone.

If the patient couldn’t be reached, the pharmacists were told to wait until Friday and then fill the prescription anyway.

Barna repeatedly warned CVS pharmacists under his supervision that they had to meet quotas for refilling prescriptions, or scripts.

“Remember,” he said in one email, “each of you owns scripts and has an obligation to meet your weekly script budget; this is one of the areas you’ll be evaluated on come review time.”

Refilling prescriptions without a patient’s approval raises the possibility of insurance fraud, state officials say. Claims are submitted to insurers when an order is filled, not when a patient picks up the medicine. Drugs that are not claimed by patients presumably would be restocked and money refunded to insurers.

I heard from a number of current and former CVS pharmacists in California and elsewhere who confirmed that they were under tremendous pressure from the company to keep refill dollars flowing in. The pharmacists requested anonymity because they either still work for CVS or remain active in the pharmacy business.

None of the pharmacists said they’d been given explicit instructions to refill prescriptions without patient approval. But a CVS pharmacist in Pennsylvania said he had received a call from his district manager after my column ran last week “telling us to stop the practice and only fill scripts if the patients want them.”

A pharmacist who said he worked at a CVS branch in Los Angeles from 2006 to 2007 claimed first-hand knowledge that some co-workers weren’t canceling claims and refunding money to insurers for restocked drugs. This was done, he said, to boost the store’s numbers for evaluations of individual branches.

Virginia Herold, executive officer of the California Board of Pharmacy, which licenses pharmacies and pharmacists, said her agency would investigate CVS if a sufficient number of complaints were lodged by consumers. This can be done online at https://www.pharmacy.ca.gov.

Herold also said this would be a situation in which insurers — including Medicare — should consider filing complaints.

“The insurance company may be paying for something that’s not being delivered,” she said. “Given the health premiums we pay, I can’t believe they would be happy about that.”

Wes Davis, 71, of San Dimas said he experienced multiple incidents of ordering refills of his allergy medicine by phone and then finding that CVS had filled the order twice and submitted two claims to his insurer.

“They were double ordering,” Davis said. “I would tell them that I only needed one refill, and they would say that they would hold on to the rest for their inventory.”

Janet Mace, 66, of East Orange, N.J., told me about her 90-year-old mother who required pain killers and anti-nausea drugs after undergoing surgery for a broken wrist. She filled the prescriptions at her local CVS.

“Then my mother started getting calls from them saying that her prescriptions had been refilled and were ready for pickup,” Mace said. “She told them she didn’t order any refills, that she didn’t want any refills. But she kept getting the calls.”

Mace wonders if her mother’s insurer, Medicare, was even aware of what was going on.

My hunch: No. But Medicare and other health insurers now might want to pay more attention to the claims they’re receiving and whether their patients are actually ordering meds.

David Lazarus’ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send tips or feedback to david.lazarus@latimes.com.