Figure B Basic Flow for CVS Prescription Fulfillment Process

Drop$-$off

$-$z$>$uz$+$OK$>$

V

E

T

R

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Source: CVS$.$

Dr$.$ call

Data

Entry

Data entry

or

RPh

Production

Production

INVENTORY

Quality

Assurene

Consult

area

Shelves

Quality

Assurance

Nick$-$u

Standard

script path

Drug utilization review As soon as data entry was complete, the system performed an

automated "drug utilization review" $($DUR$).$ The DUR checked the script against all other

prescriptions in the database for that patient $($in other words, all prescription drugs that had ever

been dispensed by CVS to the patient$)$ to see if there existed any possibility for harmful drug$-$drug

interactions. The DUR also checked to make sure the drug was appropriate for the patient, given the

patient's age, gender, and other demographic data stored in the system$^3$

If the DUR revealed any potential problems, the systems came to a "hard stop" and fulfillment

could not proceed until the DUR was reviewed by a pharmacist. In the great majority of cases the

pharmacist did not need to involve the customer when reviewing the DUR. In fact, many within the

industry considered it better for the customer not to be involved, reasoning that if the DUR gave the

impression that a prescribed drug could be harmful, the customer might be less likely to take it$.$

Everyone at CVS felt that the DUR was an essential part of good pharmacy operations and

customer service and that the automated review should be a very careful and conservative one.

Insurance check After the DUR was complete and any hard stops were reviewed, the system

performed an insurance check. Most CVS pharmacy customers had their prescriptions paid for by a

third party such as an employer, an insurance company, or a government agency. These customers

CVS maintained a separate application that allowed customers to request refills via telephone This system stored refill

requests until $1\mathrm{.}5$ hours before the requested pickup time, then transferred them to the pharmacy system for fulfillment,

beginning with the DUR.