A flurry of prescription pills – all different colors, shapes and sizes – pass across white counters. It almost looks like a blur of betting chips thrown across the slick surface. The click-clacking and pinging sounds they make as they ricochet off the sides of the metal pill counting tray create a white noise similar to that of a casino.
While it may appear to be a scene from the Vegas strip, it’s actually the high speed processing that takes place behind the counter of your neighborhood pharmacy.
A gamble, yes, but there is more than just money at stake. High speed dispensing too often comes at a risky price of compromised patient safety in exchange for maximized productivity and profits. With risks of potentially fatal drug interactions resulting from dangerous combinations, the winners and losers are differentiated by more than just a jackpot.
As evidenced by the Chicago Tribune’s recent study, many of today’s medication dispensing practices exemplify the need for speed to satisfy corporate productivity pressures. With success and compensation bonuses based primarily on high volume dispensing, pharmacists and staff may cut corners and compromise patient safety standards in order to meet targets.
While these targets are the focus behind the counter, the consequences for a missed alert can be staggering. Priority one should be protecting the patient, including identifying potential drug interactions. In a day-to-day battle that seems to constantly pit speed against safety, pharmacists are caught in the middle and patients are unknowingly playing a risky game of prescription roulette.
The pharmacists’ plight is not a new one. Fast paced and management free dispensing to facilitate consumer convenience and corporate production expectations fuel the multibillion-dollar pharmacy industry.
Pharmacies value high volume dispensing, and as found by the Chicago Tribune article, more than 50 percent of the time the tested pharmacies were in such a rush to dispense that they did not tell patients about potential interactions.
With patient safety being an industry priority, models that promote management, pharmacy accountability and compliance are in high demand.
A more cautious approach may be viewed as “slowing” the dispensing process, but if we apply the tortoise and the hare fable to the return to work race, safe and steady always wins. Prospectively managed medication dispensing improves compliance and patient safety and lowers pharmacy risk.
The pharmacies in the Tribune study were processing medications outside of prospective and concurrent pharmacy benefits manager (PBM) management. While internal alerts are built into pharmacy processing systems to warn pharmacists, they do not require any action. And, after so many endless, seemingly meaningless warnings, it is common for pharmacists to become desensitized. PBMs on the other hand add a second layer of safety to the dispensing process. PBM alerts require edits via overrides and phone calls. This requirement for an affirmative response disrupts the anesthetized alert fatigue and dramatically increasing pharmacist compliance.
In a prospectively managed PBM model, Drug Utilization Review (DUR) edits scan patients’ medication histories and flag unsafe drug interactions. These contraindications alert pharmacists to review each flagged medication to determine the clinical significance. Unlike the episodes detailed in the article, where the medications were processed and dispensed by the referenced pharmacies outside of PBM management, the PBM requires concurrent reviews to be performed by the pharmacist for payment.
CorVel delivers the resources to support accountable and safe medication dispensing. In addition to call centers fully staffed with CorVel associates that assist pharmacists nationwide, CorVel’s Certified Pharmacy Technicians work with pharmacies and share information with adjusters to improve decision-making, combatting the slowness that may mistakenly be associated with safety. By addressing key indicators at the front end through alerts and actionable data, prospective management promotes accuracy in concurrent interventions, ultimately driving safe pharmacy utilization practices.
At a time where risks stemming from the overuse and abuse of narcotic pain medications, and unmanaged prescription medications top payors’ lists of concerns, CorVel’s managed dispensing model holds a unique position within industry. CorVel’s process disrupts unmanaged dispensing and holds pharmacies accountable to PBM contracts.
CorVel’s program reduces risk of overdose, no risk of interacting medications and lowers the risks of opioid addiction, all of which contribute to significant savings and better care for patients. Everyone wins.
Boards of directors could face a fresh wave of directors and officers (D&O) claims following the introduction of tough new cybersecurity rules for financial institutions by The New York State Department of Financial Services (DFS).
Prompted by recent high profile cyber attacks on JPMorgan Chase, Sony, Target, and others, the state regulations are the first of their kind and went into effect on March 1.
The new rules require banks, insurers and other financial institutions to establish an enterprise-wide cybersecurity program and adopt a written policy that must be reviewed by the board and approved by a senior officer annually.
The regulation also requires the more than 3,000 financial services firms operating in the state to appoint a chief information security officer to oversee the program, to report possible breaches within 72 hours, and to ensure that third-party vendors meet the new standards.
Companies will have until September 1 to comply with most of the new requirements, and beginning February 15, 2018, they will have to submit an annual certification of compliance.
The responsibility for cybersecurity will now fall squarely on the board and senior management actively overseeing the entity’s overall program. Some experts fear that the D&O insurance market is far from prepared to absorb this risk.
“The new rules could raise compliance risks for financial institutions and, in turn, premiums and loss potential for D&O insurance underwriters,” warned Fitch Ratings in a statement. “If management and directors of financial institutions that experience future cyber incidents are subsequently found to be noncompliant with the New York regulations, then they will be more exposed to litigation that would be covered under professional liability policies.”
Judy Selby, managing director in BDO Consulting’s technology advisory services practice, said that while many directors and officers rely on a CISO to deal with cybersecurity, under the new rules the buck stops with the board.
“The common refrain I hear from directors and officers is ‘we have a great IT guy or CIO,’ and while it’s important to have them in place, as the board, they are ultimately responsible for cybersecurity oversight,” she said.
William Kelly, senior vice president, underwriting at Argo Pro, said that unknown cyber threats, untested policy language and developing case laws would all make it more difficult for the D&O market to respond accurately to any such new claims.
“Insurers will need to account for the increased exposures presented by these new regulations and charge appropriately for such added exposure,” he said.
Going forward, said Larry Hamilton, partner at Mayer Brown, D&O underwriters also need to scrutinize a company’s compliance with the regulations.
“To the extent that this risk was not adequately taken into account in the first place in the underwriting of in-force D&O policies, there could be unanticipated additional exposure for the D&O insurers,” he said.
Michelle Lopilato, Hub International’s director of cyber and technology solutions, added that some carriers may offer more coverage, while others may pull back.
“How the markets react will evolve as we see how involved the department becomes in investigating and fining financial institutions for noncompliance and its result on the balance sheet and dividends,” she said.
Christopher Keegan, senior managing director at Beecher Carlson, said that by setting a benchmark, the new rules would make it easier for claimants to make a case that the company had been negligent.
“If stock prices drop, then this makes it easier for class action lawyers to make their cases in D&O situations,” he said. “As a result, D&O carriers may see an uptick in cases against their insureds and an easier path for plaintiffs to show that the company did not meet its duty of care.”
One area that regulators and plaintiffs might seize upon is the certification compliance requirement, according to Rob Yellen, executive vice president, D&O and fiduciary liability product leader, FINEX at Willis Towers Watson.
“A mere inaccuracy in a certification could result in criminal enforcement, in which case it would then become a boardroom issue,” he said.
A big grey area, however, said Shiraz Saeed, national practice leader for cyber risk at Starr Companies, is determining if a violation is a cyber or management liability issue in the first place.
“The complication arises when a company only has D&O coverage, but it doesn’t have a cyber policy and then they have to try and push all the claims down the D&O route, irrespective of their nature,” he said.
“Insurers, on their part, will need to account for the increased exposures presented by these new regulations and charge appropriately for such added exposure.” — William Kelly, senior vice president, underwriting, Argo Pro
Jim McCue, managing director at Aon’s financial services group, said many small and mid-size businesses may struggle to comply with the new rules in time.
“It’s going to be a steep learning curve and a lot of work in terms of preparedness and the implementation of a highly detailed cyber security program, risk assessment and response plan, all by September 2017,” he said.
The new regulation also has the potential to impact third parties including accounting, law, IT and even maintenance and repair firms who have access to a company’s information systems and personal data, said Keegan.
“That can include everyone from IT vendors to the people who maintain the building’s air conditioning,” he said.
Others have followed New York’s lead, with similar regulations being considered across federal, state and non-governmental regulators.
The National Association of Insurance Commissioners’ Cyber-security Taskforce has proposed an insurance data security model law that establishes exclusive standards for data security and investigation, and notification of a breach of data security for insurance providers.
Once enacted, each state would be free to adopt the new law, however, “our main concern is if regulators in different states start to adopt different standards from each other,” said Alex Hageli, director, personal lines policy at the Property Casualty Insurers Association of America.
“It would only serve to make compliance harder, increase the cost of burden on companies, and at the end of the day it doesn’t really help anybody.”
Richard Morris, partner at law firm Herrick, Feinstein LLP, said companies need to review their current cybersecurity program with their chief technology officer or IT provider.
“Companies should assess whether their current technology budget is adequate and consider what investments will be required in 2017 to keep up with regulatory and market expectations,” he said. “They should also review and assess the adequacy of insurance policies with respect to coverages, deductibles and other limitations.”
Adam Hamm, former NAIC chair and MD of Protiviti’s risk and compliance practice, added: “With New York’s new cyber regulation, this is a sea change from where we were a couple of years ago and it’s soon going to become the new norm for regulating cyber security.” &