Will a CVS Caremark Mail-Order Pharmacy License be Revoked?

Will a CVS Caremark Mail-Order Pharmacy License be Revoked?


A Pharmacist Activist reader called my attention to an article in STAT+, “California wants to revoke a CVS mail-order license for illegally filling opioid and ADHD prescriptions” (Ed Silverman, Dec. 21, 2022).

The Accusation (Case No. 7258) was filed on October 10, 2022 by the Executive Officer of the Board of Pharmacy of California against CVS/Caremark PCS Pennsylvania Mail Pharmacy LLC doing business as CVS Caremark or Ingenio Rx Home Delivery and four of its officers. The Accusation identifies the following causes for discipline:

  1. Requirements (California’s) for Dispensing Controlled Substance Prescriptions;
  2. Failure to Exercise or Implement Corresponding Responsibility;
  3. Gross Negligence;
  4. Clearly Excessive Furnishing of Controlled Substances;
  5. Unprofessional Conduct – Violation of Applicable Pennsylvania Laws and Regulations Governing Pharmacy;
  6. Unprofessional Conduct.

A hearing is requested on the matters alleged, and that following the hearing, the Board of Pharmacy issue a decision:

  1. Revoking or suspending the Nonresident Pharmacy Permit issued to the pharmacy;
  2. Prohibiting the four officers of the pharmacy from serving as a manager, administrator, owner, member, officer, director, associate, or partner of a licensee for five years if the Nonresident Pharmacy Permit is placed on probation or until the Permit is reinstated if it is revoked;
  3. Ordering CVS Caremark PCS Pennsylvania Mail Pharmacy to pay the Board of Pharmacy the reasonable costs of the investigation and enforcement of this case.

The California Board Inspector reviewed the pharmacy’s dispensing records from July 6, 2018 through July 6, 2021 and identified the following dispensing trends and multiple objective factors of irregularity:

1. Excessive furnishing/early dispensing of prescriptions;

During the 3-year period, the pharmacy filled/dispensed over 2,100 prescriptions for controlled substances (my emphasis), representing more than 69,000 tablets or other dosage units more than seven days early to 549 California patients.

2. Prescriptions written by out of state prescribers;

Controlled substances may only be prescribed by a California licensed prescriber when dispensed to patients in California. The Board Inspector reviewed the top 100 prescribers of controlled substances dispensed by the pharmacy and was able to confirm that only three had active unrestricted licenses to practice in California during at least part of the time for the time period reviewed. Over 6,800 prescriptions were dispensed to patients in California from prescribers listed as having offices in other states, including 2,665 prescriptions for Schedule II controlled substances (my emphasis), representing more than 316,000 dosage units. The pharmacy did not provide the Board Inspector any documentation to show that a pharmacist interviewed each patient to determine the authenticity of the prescriptions written by out of state prescribers.

3. Variation from prescriptions;

The Board Inspector found that the pharmacy deviated from the prescription instructions and dispensed 55 prescriptions against prescribers’ orders that had clear instruction that the prescription “must last” a certain amount of time or have a “maximum” amount per day that could be taken. The pharmacy dispensed these prescriptions early.

The California Board of Pharmacy is to be commended for its thorough investigation of this pharmacy, and it and the Pennsylvania Board of Pharmacy should revoke the license/permit of the pharmacy. It is not possible to estimate the number of individuals who were harmed or died as a consequence of the alleged illegal dispensing of hundreds of thousands dosage units of controlled substances from this pharmacy. However, there have to be victims of this alleged irresponsible and unprofessional conduct. The penalties requested for the four officers are not sufficient. They should receive prison terms, and there should be further investigation of the extent to which their actions were expected or encouraged by their parent company.

There should be no higher priority for Boards of Pharmacy in every state to conduct similar investigations of mail-order pharmacies for which it provides licenses or permits. These pharmacies have essentially escaped regulatory monitoring and actions. The primary duty and responsibility of Boards of Pharmacy is to serve and protect the interests and welfare of the residents of their states with respect to the services and actions of the individuals and facilities which they license and regulate. If they are not doing so already, they must investigate the dispensing practices of the pharmacies from which the largest number of prescriptions are dispensed. The California Board of Pharmacy has provided the example and model for doing this.

4 Responses

  1. I see nothing wrong with the pharmacy filling them early. They are a mail order pharmacy that certain CMS plans utilize. They are not overnighted and it could take days before they are received by the patients. They need to talk to the patients whose meds were not received yet or received late.

  2. 1,095 days in 3 years= 2,100 prescriptions which doesn’t really sound excessive to me. They are the pharmacy for GEHA, a government insurance provider, among other providers. Wouldn’t someone take into consideration how many patients they serve, how many surgeries are done, how many people don’t get those prescriptions there? This writer says there is no way to see if anybody died because of this. WEAK. Sure there is. Call and count. But wait. Throwing out accusations that are not supported is more likely to get “approval than using actual DATA.

    Or am I over-simplifing it?

  3. I’m guessing it’s because of the early refills-not that I think they should have their license revoked but a week early would be a major no no in a pharmacy unless it was a vacation over ride but that’s a lot of over rides then.

  4. This is completely outrageous. I used to use Expeess Scripts when in Ct, which sent both ADHD & my opiod medications monthly to my home address! What’s wrong with Caremark doing the same for their clients?

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