The state Division of Consumer Affairs and CVS-Caremark reached an agreement addressing the commingling of prescription drugs at five New Jersey locations in 2012.
A total of 15 parents who filled their children's chewable fluoride prescriptions in December 2011 and January 2012 at the CVS Pharmacy on Main Street in Chatham Borough reported noting tablets in the bottles that were not like the others. The strange pills turned out to be the breast cancer drug tamoxifen.
Both pills are white, round and about the same size. Tamoxifen pills have the letter "M" stamped on one side and "274" on the other. Fluoride pills have the letters "SCI" on one side and the numbers "1007" on the other.
Attorney General Jeffrey S. Chiesa and the DCA said after the commingled prescriptions in Chatham went public, CVS came forward when customers in four other New Jersey towns received pill bottles with the wrong medications:
- Three customers at a CVS in Cherry Hill received bottles which commingled metoprolol, a high blood pressure drug, with the schizophrenia drug risperidone on or about March 3, 2012.
- One customer at a CVS in Budd Lake was given pravastatin, a cholesterol drug, instead of metformin, a diabetes medication. This customer was concerned she consumed the wrong medication and visited an emergency room on or about March 7.
- A CVS in Rahway filled a prescription calling for 80 mg. tablets of Coreg, a blood pressure drug, at 20 milligrams per tablet on or about March 11. No patients are known to have taken the wrong dosage.
- A CVS in Scotch Plains dispensed about 30 prescriptions from an automated filling machine in which pills for atorvastatin, a cholesterol drug, were accidentally commingled with pills for losartan, a blood pressure drug. There is no indication that patients took the wrong medication.
CVS reached out to all potentially affected consumers and notified the DCA and the State Board of Pharmacy.
The DCA launched an inquiry into CVS and ordered them to produce extensive documentation of these instances. Corporate representatives were ordered to appear in person at DCA headquarters in Newark and answer questions under oath about the Chatham CVS operations and other incidents of commingled prescriptions.
Some of these errors took place "when employees overlooked or circumvented the company's longstanding procedures" on returning unclaimed prescriptions to pharmacy stock, according to a press statement from the DCA.
"For example, when returning unclaimed prescriptions back to store inventory, employees may have poured the pills into the wrong stock bottles even though CVS policy dictated that unclaimed prescriptions should not be returned to stock bottles at all," the statement reads.
Other errors took place when staff loaded the bins for the automated filling machines with pills that had been improperly mixed, according to the statement.
Eric T. Kanefsky, the acting director of the DCA, said CVS agreed to "a significant payment" to help further public education about prescription drug safety. "The prescriptions that pharmacies dispense include Controlled Dangerous Substances (CDSs). The fight against the abuse and diversion of dangerous medications, including CDS, has been a priority of the Division in recent years."
CVS-Caremark agreed to pay $650,000 to the DCA for a public awareness campaign about the dangers of prescription drug abuse. This payment will also reimburse the DCA for attorneys’ fees and investigative costs incurred during its inquiry into CVS.
CVS developed enhanced procedures for the automated filling machines, and stopped use of the machines until after all specialists could be retrained.
Head pharmacists will have to do a monthly quality assurance review, and district supervisors will conduct store visits once a month to ensure procedures are being followed.
CVS also put in access to the New Jersey Prescription Monitoring Program in every New Jersey pharmacy. This database is maintained by the DCA and tracks prescription drugs for their potential illegal diversion and abuse.
If any future instances of commingling come up, CVS must notify the DCA within three days and provide a full report, including a summary of the investigation and an assessment of the source of the error, within 10 days.
CVS also agreed to put color images and clinical information of medication on their website, so customers can view their personalized prescription profile online to see what their medications should look like. Customers will also receive notices to check their medication with the written description on the bottle
Neal Buccino of the DCA said CVS "was very cooperative and informed us of these matters as they came up," and continued to cooperate with the DCA throughout their inquiry.
"This was the best way to resolve this in a way to make sure the public safety was addressed," Buccino said.