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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

Maila Aganon is the personification of the American dream. The vice president of treasury and risk for Caesars Entertainment Corp. immigrated from the Philippines and worked her way to the top.
By: | October 12, 2017 • 4 min read


R&I: What was your first job?

I actually had three first jobs at the same time at the age of 16. I worked as a cashier in a fast-food restaurant, a bank teller and a debt collector for an immigration law firm.

R&I: Who is your mentor and why?

I have a few. The first one would be the first risk manager I reported to. He taught me the technical part of the job, risk financing, captives and insurance. I am also privileged to be mentored by Lori Goltermann (CEO of U.S. Retail for Aon Risk Solutions).  From her I learned to be resilient and optimize life/work balance. Then of course I also have a circle of ladies at work who I lean in to!

R&I: How did you come to work in this industry?

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I was once a bank teller and had a client who was an insurance agent. He would come in every day to make deposits. One day, he offered me a job. He said, “How would you like to have your own desk, your own phone and your own computer?” And I said, “When do I start?” I worked for this personal lines insurance company for six years.

R&I: Did you take to it immediately?

Yes, I did sales, claims and insurance accounting. I left for a couple years and that is when AAA came calling, which was my first introduction to risk management. I didn’t know there was such a thing as commercial insurance. They called me and the pitch was “how would you like to run a captive insurance company?”

R&I: What have you accomplished that you are proudest of?

It is not so much the job but I say that I am the true product of the American Dream. I came to the U.S. when I was 16. I worked three jobs because I didn’t want to go to high school (She’d already graduated high school in the Philippines.) I spoke very little English, and due to hard work, grit and a great smile I’m now here working with all of you!

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

In movies, it is a toss-up between Gone with the Wind and Big Daddy.

R&I: What is your favorite drink?

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I like anything sweet. If you liquify a dessert that’s my perfect drink.

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

This is easy because I just got back from Barcelona on a side trip. I visited the Montserrat Monastery, which is a thousand-year old monastery. It was raining and foggy. I hiked for three hours and I didn’t see a single soul. It was a very peaceful place.

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

This is going back to working at a fast food chain when I was young. I worked in a very undesirable location in San Francisco. At 16 I used to negotiate with gang members so they wouldn’t rob me during my shift. I had to give them chicken so they wouldn’t rob me.

Maila Aganon, VP, Treasury and Risk, Caesars Entertainment Corp.

R&I: If the world has a modern hero, who is it and why? 

I can’t say me. They have to be my kids Kyle and Hailey. They can make me laugh and cry within a half-minute of each other. Kyle is 10, a perfect Mama’s boy. Hailey is seven going on 18.

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

I think the most fulfilling part is how you build relationships with people and then after a while they become your friends.

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

Risk managers do a great job of networking. They are number one. Which is not a surprise because the pillar of our work is building a relationship with underwriters, clients and brokers.

R&I: What could the risk management community be doing a better job of? 

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I am experiencing that right now; talent.  We need to a better job in attracting and retaining talent. Nobody knows about what we do. You tell someone ‘I’m as risk manager’ and they give you a blank look. What does that mean?

We’re great marketers and we should use this skill set in attracting talent. We should engage our universities, our communities, even our yoga groups and talk to them about the exciting world of risk. It is an exciting career because there is nothing like it.

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

It would have to be the increasing cyber risk and the interdependency of systems.

R&I: What does your family think you do? 

I took my seven year old daughter once to an insurance event that had live music, dancing and drinks. She thinks that whenever I go to an insurance meeting, I’m heading to a party.




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