Pass any establishment containing a pharmacy and at some point you will see an offer on their marquee for a gift card with a new or transferred prescription. Often, you can see it on more than one pharmacy’s marquee at the same time. All three major chains, CVS, Rite Aid and Walgreen’s routinely run ads offering a $25 (or more) gift card with a new or transferred prescription. On the surface this looks like a sure fire way to get new customers into the store (and it does help inflate the sales figures and prescription counts nicely, too). The reality, however, is something very different.
The reality is that the executives of each company have started to believe their own marketing results without question or examination, to the detriment of the company’s operations and the safety and welfare of the patient. But that’s executive thinking in any business: the numbers looks good so why question expected results? It did work for Enron and Bear-Sterns, after all. Time and again managements will cite unseen studies showing the number of customers such offers bring in. And they do. Originally, the gift card offer was an effective way of announcing a new location opening. But, some marketing executive found himself reasoning, if it works for new store openings, why not at other times? And so began the Gift Card Game. The numbers coming in look good, but these same people clearly do not look at the numbers of prescriptions going back out as the next competitor offers up $25 gift card.
The patients, no dummies when it comes to free stuff, are acutely aware how the Gift Card Game is played. There are even web articles that tell you how to work the system to keep getting free $25 cards out of the various pharmacies. Patients just after the gift card will transfer one or two prescriptions rather than all the medication he or she is taking. Some will even transfer one for each family member over the course of several days in order to obtain gift cards for each person; watch $25 become $100! And they will all blog about all of it later (here and here). And hey, execs. Yeah, you! You listening? Your program works so well, you can also buy the coupons in bulk on e-bay.
Patients are remarkably brazen about it., as the above article and blog links demonstrate. They have dropped off a prescription saying they would wait on it. An hour later a call would come from a competitor asking for a transfer. When asked for the transfer reason to put in the computer, the pharmacist or technician on the other end of the line would say “gift card” and they would then have to be told the prescription was just dropped off an hour ago. This scenario is a common occurrence among pharmacists. So is this one: Prescriptions that started off at, say, Rite-Aid have, over the course of several months, been transferred to Walgreen’s for their gift card, then the same prescription back to Rite-Aid for their gift card, which doesn’t actually make it a transfer. Next stop is the local CVS, and then on to Bi-Lo, who one-upped the competition with a $25 gas card during the gas crunch of 2008.
Meanwhile, each company’s executives, oblivious in that way that only executives can be, assume that for all the card redemptions, the program is a smashing success and should be repeated in a few months when for some unexplained reason transfers out have increased. Never mind all the angry customers on Medicaid and Medicare who do not qualify for the transfer offers due to Federal Laws, but do not find out until after they have brought in the new prescription or done the transfer (it’s in the fine print! Learn to read people!); their angry rants often resulting in a gift card from store management for “customer service.” This is somehow different from "presciption transfer."
On the level of the actual pharmacy operation, such programs only eat more time. Transfers are not like new or faxed prescriptions. All the information must be filled out legibly by hand: Patient’s name, date of birth, medication name, dose, strength, quantity, prescriber, prescription number assigned by original pharmacy, date prescription was written, date it was last filled, number of refills remaining, name of persons doing the transfer between the pharmacies, each pharmacy’s DEA number…for each drug transferred. When the prescription is transferred back out, all that information has to be read to the next pharmacy, while the receiving person reduces it to writing once again. Subsequent calls from patients searching for which pharmacy they have prescription “X” at occur with increasing frequency.
The bigger challenge facing pharmacists, however, is not the time transfers in and out consume, but the meeting of state laws concerning patient medication use. Most states have one of these and Tennessee is no exception. The pharmacist must conduct a Drug Utilization Review of the patient’s medications [TN Law 1140-3-.01(3)(a) and (b) ]. This screens for inappropriate use, dosing, and most importantly, potential interactions with other medications. With patients dropping off new prescriptions at multiple pharmacies in order to gain another gift card, and then transferring them about to gain still more gift cards, the DUR process becomes tricky.
The pharmacist must now try to find out what other medications the patient is taking. Many patient’s knowledge of their medications is limited to a “water pill” or “sugar pill” or “blood pressure pill” or “heart pill.” What does that mean for the pharmacist? It means the Biaxin antibiotic prescription the patient just brought in for that $25 gift card may interact in a potentially fatal way with his heart medication if it happens to be digoxin, but not so if the heart medication is atenolol. If the patient does not know the drug name or at least what pharmacy or pharmacies such drugs are coming from, the pharmacist is dispensing blindly. Describing it as a round white pill doesn’t work, either; they are both round and white in this case. The same divisive risk is run with the Publix no co-pay antibiotics promotion and Walmart’s $4 generic promotion on select drugs.
The Gift Card Game has transformed a one-time promotional idea into an unending competitive transfer carousel. The companies involved are leveraging patient’s medications in an attempt to increase spending and sales in their establishments. As seen in the blog links above, apart from the $25 of free merchandise the Gift Card Game generates, the sales increase is fleeting and illusory; the prescription will be transferred on to the next offer as soon as it appears. The most disconcerting part though, is such promotions have reached a point that patient safety and the ability of the pharmacist to do his or her job effectively is compromised. The question is, when the inevitable transfer induced medication accident occurs (and it will eventually happen), will the state’s Pharmacy Board accept as valid the “Gift Card Defense?” Perhaps. But only if it comes with a new or transferred pharmacist license.
Photo Credit: "Gift Cards" from istockphoto.com/AndrewJohnson. Used with permission.
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