The process consisted of five basic steps (refer to Figure 1), the first being the drop off. A customer would drop off a script and write the requested pickup time on the script itself, then put it in a box that was divided into a number of slots. These slots were assigned to a specific time period and the tech would put the script into the slot corresponding to the hour before the desired pickup time. The busiest times at the drop- off were before work, lunchtime, and after work. Regardless of when they dropped them off, more customers wanted to pick up their filled prescriptions after work than at any other time.
The next step would be the data entry. Each hour, a tech would take the hour’s scripts from the box and entered all required data about them into the pharmacy information system, an application used by all locations and connected to CVS’s central databases of drug, prescription, customer, payment, and insurance information.
After which is the drug utilization review. As soon as data entry was complete, the system performed an automated “drug utilization review” (DUR). The DUR checked the scripts against all other prescriptions in the database for that patient to see if there existed any possibility for harmful drug-drug interactions. The DUR also checked to make sure that the drug was appropriate for the patient, given the patient’s age, gender, and other demographic data stored in the system. Should there be any potential problems. The systems would come to a “hard stop” and the DUR would require the need for review by a pharmacist. The DUR was considered an essential part of good pharmacy operations and customer service and that the automated review should be a very careful and conservative one.
Figure 1 – CVS Service Process
When the DUR was complete and any hard stops reviewed, the system would perform an insurance check. About 90% of CVS’s pharmacy customers had their prescriptions paid for by a third party. These customers only pay a small amount of their own money. However, the payors had complicated rules about the drugs they would cover and the conditions under which they would pay for them. And they have been putting in place more and more complicated formularies to try to control their costs. This in turn complicates CVS’s work a lot and remains as one of their biggest challenge. For example if a doctor prescribes a drug that’s not on a patient’s formulary and since an insurance check is the first time is the first time anyone learns that there is a problem, the doctor, patient and payor will have to work together to switch the prescription. In addition, payors would also tighten rules about when they will allow a prescription to be refilled, so patients basically have to wait longer before coming in for a refill and the payor will refuse to cover the fill if they don’t wait long enough. All in all, in most cases, the process would continue even if one of these rules was violated. CVS employees would attempt to identify and correct the problem while the process continued or when the customer came to pick up their prescription.
The third step would be the production process where the drugs to fill the script were counted and verified by certified pharmacy technicians
The 4th step would be the quality assurance process. A pharmacist would review each script to make sure that it contained exactly the right drugs in the right quantities and that all other details were correct. This is one of the most important tasks of a pharmacist and it should never be delegated to a technician or other employees in the pharmacy. All in all, the steps from data entry to quality assurance could be completed in approximately five minutes if there were no problems.
The last step would be the pick up. After the quality assurance process, each completed script was sealed in a bag. Bags were stored in the pick up area in alphabetical area. The technician staffing the...