You might have noticed that CVS’ is like this have become a weird ghost town. Just a few people staffing an entire store while crates stack up, lines wrap around the aisles, and the one cashier has to go help someone in aisle five unlock deodorant that is for some reason imprisoned behind plexiglass. You go to a pharmacy to buy aspirin, to buy a toothbrush, and it takes you 45 minutes to get a clerk to open up the glass.
(Host) What is going on here? This is a company that made $8. 3 billion last year.
So I started digging, and what I found was shocking. The chaos in the front of the store is just the tip of the iceberg. Behind the scenes, pharmacists at CVS and local pharmacies around the country are sounding the alarm about a deliberate strategy that is putting lives at risk and threatening a key service that we all rely on to get the medication we need.
Ohio issues serious sanctions against one of the country's largest pharmacy chains for endangering patient safety. (Host) In 2023, journalist Marty Schladen got a call regarding the Ohio Board of Pharmacy, the agency tasked with regulating pharmacies, including CVS. (Marty) They found unsanitary conditions in the pharmacy.
They found expired drugs on the shelves. They go back a week later and found — find that they were still there. They found instances of mislabeling of drugs.
(Alec) Inspectors noted that the stores were severely understaffed. Much like what you've seen at the front of a CVS, too few pharmacists were left with an impossible workload. (Marty) They found ridiculously long wait times to get prescriptions filled, sometimes as long as a month.
(Alec) But CVS had an excuse for all of this. The pandemic. Covid had created a labor shortage, and pharmacists were now also being tasked with giving out an unprecedented amount of vaccines.
Marty, however, found a different explanation. There was testimony before the Board of Pharmacy by former employees that even when they requested extra help and it was available, word came down from district and regional managers that “we have to keep our hours down. ” In other words, keep expenses down.
Technicians, instead of filling this backlog of prescriptions, were being told to call people and make sure that they came and picked up their autofill prescriptions, and did they want to come in and get a flu shot? And the way that these employees, pharmacists and technicians, viewed it was CVS, instead of making sure it was doing its core function properly, was out chasing new dollars. (Alec) Pharmacists are the last line of defense in stopping deadly or harmful medication errors.
Doctors might accidentally prescribe a medication that dangerously interacts with another medication. They might prescribe a drug that is less effective than newer ones to treat the same condition. They might right the wrong dose.
It is a pharmacist’s job to prevent any of these scenarios. But here's the thing: After Marty's story got national traction, he kept hearing similar stories about CVS from all around the country. So I decided to keep the investigation going.
I talked to multiple pharmacists, dug through national reports, and reviewed a database of anonymous pharmacist complaints collected by pharmacy advocates. What I found was horrifying. A pharmacist at a CVS in South Carolina complained of having too many tasks.
“I'm going to make a mistake. It's only a matter of time and degree,” they wrote. While anonymous, it echoed what many others were saying.
In Virginia Beach, a pharmacist described conditions as “a sweatshop. ” A staff pharmacist stated hours had been cut to the point where she didn't know how the pharmacy was supposed to function. Pharmacists at a CVS specialty pharmacy in Redlands complained of pressure to cut corners as they handled temperature-sensitive drugs for cancer patients.
“I’m afraid I’m going to kill someone,” wrote one pharmacist from New York. “I am a danger to the public working for CVS,” one pharmacist wrote to the Texas State Board of Pharmacy. While many of these workers remain anonymous, we did get one pharmacist to speak on camera: Maurice Shaw, who worked for CVS in 2020, in the midst of the pandemic.
(Maurice) The phones rang constantly off the hook. Sometimes you get so busy, we grab the wrong bag so the patient gets somebody else's. (Alec) The overflowing aisles of unpacked boxes that you’ve seen on the retail side?
Well, Maurice faced a similar reality on the pharmacy side. When we look for drug a to fill, we're just digging through these totes for medication that should just be on the shelf so we could just quickly grab it and fill it and — and put it back. But it just was no time.
(Alec) With staff pressed for time, shipments of drugs would stay unorganized, forcing customers to wait days for critical, potentially life-saving medications. Maurice has since left CVS, unwilling to deal with the understaffing. There wasn't a shortage of pharmacists, that's just how they scheduled.
It's — it’s the budget that they — that they put to maximize profits. I have friends that work at CVS that tell me, like, “Man, I have a hard time sleeping at night because I just sit up all night thinking about the mistakes that I might have made. ” They're concerned about losing their license.
(Alec) Similiar problems have been reported at other chains like Walgreens. But hey, if you don't want to take a gamble on your prescriptions at a chain pharmacy, you can just go somewhere else, right? (Pharmacist) Since January 1st of this year, over a thousand independent pharmacies have closed in the United States.
(Alec) That's Benjamin Jolley, an independent pharmacist from Utah. (Benjamin) That’s a humongous number of independent pharmacies that are closing and just can’t hack it anymore. One of the biggest reasons for these closures?
Ultimately, it has a lot to do with CVS, but in a more covert way. Simply put, insurance companies aren't reimbursing independent pharmacists, like Benjamin, the full amount of money it would take for them to buy the drugs for their customers in the first place. This whole bottle of 1,000 capsules costs $30.
So it's like three cents per capsule. But I might get only paid 4 cents per capsule. So if I give you 30 capsules, I'll make a whole 30 cents on it.
That's not enough to fund the staff. That's not enough to fund the lights, the rent, whatever. (Alec) This creates a bizarre world where attracting more paying customers actually loses pharmacy's money.
And for many of these pharmacies’, the result is closure. Nearly 800 ZIP codes that had at least one pharmacy in 2015 now have zero. And for many struggling pharmacies facing closure, their only “lifeline” is coming from the people simultaneously putting them out of business.
Small pharmacies [that] were suffering from low reimbursements would get letters from the real estate arm of CVS Corporation, CVS Health, saying, “We know reimbursements are low. We know business conditions are hard. Have you thought about selling your business to us?
” In the business, they call it buy and close. They buy my pharmacy, they close it and they take the prescriptions I had and move it to the nearest CVS pharmacy. It seemingly added to the problem with understaffing and under service of patients in its existing pharmacies.
(Alec) It's important to note that CVS got big through a series of acquisitions, and not due to its quality of service. In addition to pharmacies, CVS bought Aetna, a popular health insurance provider. In 2023, CVS paid $10 billion for a chain of doctors’ offices.
Some claim CVS’ goal is to be the Amazon of health care. But here's the real grift. Those companies that are underpaying pharmacists through low reimbursements, they're called PBMs.
I'll keep it very brief. We did a whole video about them. Basically, your insurance hires them to handle prescription drug payments.
And what do you know? CVS owns one of the largest PBMs in the country, Caremark. So let's unpack that for a second.
This is Antonio Ciaccia, the former head of the Ohio Pharmacists Association and an advocate for drug pricing reform. One of the largest companies in America gets to tell the patient where they can and can't get their medicines filled. They get to set the copays from one pharmacy or one drug to another.
They also get to arbitrarily set the rates of reimbursements for the pharmacies. (Alec) With its massive market power, CVS is able to shepherd the most profitable prescriptions away from any non- CVS pharmacy and into their own stores. (Benjamin) When I submit a claim for someone's insurance, and I'll bill it to the CVS Caremark and they'll say, “Oh, sorry, this prescription can't be filled at Jolley’s.
It has to go to CVS pharmacy. ” And that has grown substantially over time. This is a medicine called Etravirine.
It's a medicine for HIV. If they have insurance through an employer, their insurance may say, “You have to get Etravirine through the mail order. ” (Alec) This anti-competitive practice where a CVS-owned PBM forces customers to use a CVS-owned pharmacy, it's not unique.
It's employed by UnitedHealthcare, which owns Optum RX, and Cigna, which owns Express Scripts — two major PBMs. Despite owning an insurance company, a PBM, and many more subsidiaries, and despite cutting many corners, CVS is struggling to please its shareholders. Alright, what's it going to take for CVS health to turn itself around?
Each one of those units is struggling to either grow sales or to grow operating profit. Uncle. Say uncle and sell it.
(Alec) As a result, CVS has been shuttering its own stores. So after years of putting independent pharmacies out of business, they're leaving fresh new pharmacy deserts where it doesn't make sense for their bottom line. And wherever CVS is still operating, they're doing so with unkempt aisles, minimal staffing and dangerous practices.
Why? Because it's cheaper. Because they can.
Where are you going to go? Walgreens, where it's exactly the same? Fortunately, there are efforts to improve this bleak reality both at CVS and in pharmacy more broadly.
The state of Ohio, for instance, told CVS that they had had enough. (Marty) The Board of Pharmacy inspections and our reporting led the Board of Pharmacy to adopt strict new regulations. All prescriptions in Ohio now have to be filled within 72 hours.
Pharmacists now have broad new powers. If they feel like they're too overwhelmed to do their jobs properly, they can require more staffing. They can't be retaliated against for doing that.
Fines were handed out. (Antonio) They threw the proverbial book at them and fined them over $1 million, which I know doesn’t sound a lot, right, but from a precedent perspective, the gloves were taken off and CVS was put on notice that the business of old was not going to be allowable in the future. Additionally, the Pharmacist Guild and people like Maurice are successfully unionizing chain pharmacies like CVS across the country.
One of their goals? To protect pharmacists from the kind of understaffing that puts patients at risk. There's also a bipartisan bill in Congress that targets some of the worst behaviors of CVS Caremark and other PBMs.
(Antonio) The Pharmacist Fight Back Act is really predicated on getting at the heart of some of the conflicts within the PBM industry. If they make money off of setting arbitrarily high rates of reimbursement for the pharmacies they own, and arbitrarily low rates for the pharmacies that they don't own, this bill is really centered on going after that inherent conflict to create a more standardized method of payment for pharmacies that isn't subject to the whims and desires of conflicted actors in the PBM marketplace. (Alec) The Pharmacists Fight Back Act would remove some of the tools CVS uses to push independent pharmacies out of business.
When it comes to federal programs like Medicaid and Medicare, the bill bars PBMs from restricting and manipulating patients use of in-network pharmacies. It also sets minimums for drug reimbursements. It's an important first step for reining in CVS and the other corporations that are getting rich at the expense of American consumers.
(Maurice) The bill will help independent pharmacies when they fill prescriptions — stop them from losing money. (Alec) CVS’ response? Well, they just named the president of Caremark as their new CEO.
So the guy running CVS’ PBM, the arm of the company stiffing independent pharmacists and forcing consumers to use CVS pharmacies, is now running the whole show. So don't expect them to clean up their own game. Outside pressure is more crucial now than ever.
In the meantime, I'll be right here waiting for someone to come unlock the deodorant.
