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Rx Roulette

Patient risk versus pharmacy productivity.
By: | March 3, 2017 • 4 min read

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.

Risk versus Reward

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.

The Safe Bet

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.

A Sure Thing

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.

This article was produced by CorVel Corporation and not the Risk & Insurance® editorial team.



CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

As risk manager for a cloud computing and software company, Laurie LeLack knows that the interconnected economy and cyber security remain top risks.
By: | December 14, 2017 • 4 min read

R&I: What was your first job?

One of my first jobs was actually at a local insurance agency when I was a high school student, before I had any idea I was going to get into insurance. After college, I was a claims analyst at Sunbeam.

R&I: How did you come to work in risk management?

I fell into it after college, where I studied international business. I had a stack of resumes, and Sunbeam came to Florida from Rhode Island, so I applied. I interviewed with the director of risk management and just stuck with it and worked my way up.

R&I: What is the risk management community doing right?

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Getting a holistic view of risk. Risk managers are understanding how to get all stakeholders together, so we understand how each risk is aligned. In my view, that’s the only way to properly protect and serve our organizations.

R&I: What could the risk management community do better?

We’ve come a long way, but we still have to continue breaking down silos at organizations. You also have to make sure you really understand your business model and your story so you can communicate that effectively to your broker or carrier. Without full understanding of your business, you can’t assess your exposures.

R&I: What was the best location and year for the RIMS conference and why?

Being on the East Coast, I like Philadelphia.

Laurie LeLack, Senior Director, Corporate Risk and Americas Real Estate, Citrix Systems Inc.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Organizations understanding their cyber risk exposures and how this line of insurance can best protect them. Five to ten years ago, people shrugged it off as something just for technologies companies. But you can really see the trend ticking up as a must-have. It was always something that was needed, but people came to their own defining moments as we got more involved in electronic content and social media globally. Cyber risk is inherent in the way we do business today.

R&I: What emerging commercial risk most concerns you?

The advent of security and contractual obligations. These are concerns as we all play a part in this big web of a global economy. There’s that downstream effect — who’s going to be best insulated at the end of the day should something transpire, and did we set the right expectations?

R&I: Is the contingent commission controversy overblown?

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I think so. At the end of the day, it’s all about the transparency you’re getting from the people you work with. I think some best practices in transparency came out of the situation, but we were working on a fee basis, so it wasn’t as much of an issue for us as it may have been for other companies.

R&I: Are you optimistic about the U.S. economy or pessimistic and why?

I’m cautiously optimistic. We seem to be stable in terms of growth, and I’m hoping that the efficiencies and the economies of scale we achieve through technology will benefit us. But I’m also worried about the impact that could have on the number of jobs globally.

R&I: Who is your mentor and why?

Robert O’Connor, my former director when I was first on-boarded at Sunbeam, gave me so many valuable tidbits. I’ll call him to this day if I have an idea I want to bounce off him. He’s a good source of comfort and guidance.

R&I: Of what accomplishment are you most proud?

I have two very empathetic, healthy and happy boys. Eleven and soon-to-be 14.

On the professional side, there were a lot of moments during my career at Citrix where we were running a very lean organization, so I had the opportunity to get involved in many different projects that I probably wouldn’t have had in other larger organizations.

R&I: What is your favorite book or movie?

My favorite movie is Raiders of the Lost Ark.

R&I: What’s the best restaurant you’ve ever eaten at?

A place in Santa Barbara called Bouchon.

R&I: What is the most unusual/interesting place you have ever visited?

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Caverns in Gatlinburg, Tennessee. They were interesting. It was cool to see these stalagmites and stalactites that have been growing for millions of years, and then just above ground there are homes from the 1950s.

R&I: What is the riskiest activity in which you’ve ever engaged?

Riding on the back of my husband’s Harley.

R&I: What about this work do you find the most fulfilling or rewarding?

I like educating people and helping them find their ‘aha’ moment when you highlight areas of risk they may not have thought about. It allows people to broaden their horizons a little bit when we talk about risk and try to explore it from a different angle. I try not to be the person who always says “No” because it’s too risky, but find solutions that everyone is comfortable with given a risk profile.

R&I: What do your friends and family think you do?

I tell my kids I protect people and property and sometimes the things you can’t feel or touch.




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]