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"For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future." Jeremiah 29:11
Each issue will include an editorial on a topic that is important for the profession of pharmacy, as well as a review of a new drug that includes a comparison of the new drug with previously marketed drugs that are most similar in activity, and a New Drug Comparison Rating (NDCR) for the new drug. Read on for this month's issue.

April 1, 2024 Issue [Download PDF format]
In this issue:
CVS Health Changes Corporate Name to SVC Wealth
EDITORIAL:

CVS Health Changes Corporate Name to

SVC Wealth

CVS announced today that it is changing its official corporate name to SVC Wealth. Spokesman Mickey D. Angelo explained in a press conference that the decision resulted from a series of events that had been very thoroughly deliberated by company executives, numerous consultants, and members of the Federal Trade Commission (FTC).

The company had been monitoring the increasing media coverage of errors and violations in its stores, as well as strong criticisms from its own pharmacists and technicians. However, the company had been generally successful in attaining confidential settlements and suppressing media coverage of serious errors and events, characterizing errors as rare, faulting rogue employees who are no longer with the company, attributing understaffing and a toxic workplace culture to a national shortage of pharmacists, appeasing pharmacy associations, boards, and colleges with educational grants and scholarships, and claiming immunity for any other errors or problems by faulting the pandemic.

"Profits, share values, and executive salaries/bonuses continue to be our highest priorities," noted the spokesman, "and we are able to attain those goals through our use of efficiency metrics for hours of staffing, prescription and vaccine administration quotas, and effectively responding to baseless allegations of monopolistic business operations. Customers keep coming back so they must be satisfied, even though they may have to wait in long lines or experience other delays in obtaining their prescriptions."

As the press conference continued it became evident that what CVS executives had not anticipated was the cumulative impact and media coverage of what the company characterized as isolated incidents in Indiana, Ohio, Virginia Beach, and Kansas City. Individually and collectively, these incidents sparked an avalanche of attention and negative publicity from regulators and investigative journalists. As one example, the situation at the Virginia Beach CVS store exposed the previously unrecognized company "Flexible metrics" strategy. CVS has always described errors as "rare" occurrences but without ever defining "rare." A Virginia Board of Pharmacy inspector had reviewed a sample of 200 prescriptions at the Virginia Beach store and found a 37% error rate. It is alleged that CVS uses the following selective flexible metric scale for its Virginia stores:

FrequencyPercentage error rate
Very rareLess than 1%
Rare1% - 37%
Somewhat rare38% - 49%
Isolated50% - 85%
Common86% - 98%
Frequent99% - 100%

The walkout of some CVS pharmacists in Kansas City because of concerns about patient safety and working conditions created another public relations nightmare for CVS that resulted in its President of pharmacy operations quickly traveling to Kansas City to assure the pharmacists that changes would be made. However, his assurances were immediately "clarified" by executives at headquarters and, once the pharmacists returned to work and the media coverage diminished, management apparently concluded that changes were not necessary. At least one of the pharmacists who participated in the walkout is no longer employed at CVS. However, he has been seen in public and his safety is not thought to be in jeopardy.

The Kansas City CVS walkout has, however, assumed a life of its own, and some are viewing it as Pharmacy's version of the Boston Tea Party. The Pharmacy Guild has been formed, and pharmacists who are dedicated to improving patient safety and working conditions are recruiting members.

To add to these challenges facing CVS, the FTC has requested comprehensive records and documents regarding its operations, particularly those of its PBM, Caremark. Somehow, it had escaped the recognition of previous FTC commissioners that a corporation that owned almost 10,000 pharmacies, clinics, one of the largest health insurance companies, one of the largest PBMs, a long-term care company, a home healthcare company, and some government officials (not yet fully documented) might engage in some monopolistic business practices. However, in spite of the claims of the CVS executives that the closures of hundreds of independent pharmacies are coincidental, the company has concerns that the current FTC commissioners have information that confirms anticompetitive actions.

Name and logo

The corporate name CVS is one of the most widely recognized of all company brands, but independent polling shows that few know the origin of the three-letter designation. In the most recent national poll, individuals were asked to choose from the following four options the words from which CVS is derived. The answers selected by all respondents, and the answers of CVS pharmacists in the subgroup analysis are also provided.

All respondentsCVS pharmacist respondents
a. convenience, value, service2%1%
b. consumer value stores6%9%
c. confusion, venality, stress90%55%
d. cyclic vomiting syndrome2%35%

Follow-up questions revealed that a large majority of respondents including many CVS executives considered option "d" to be a fabricated and repulsive distracter, whereas pharmacists recognized it to be a known medical disorder and, perhaps influenced by workplace experience and emotion, 35% selected this option. Consumers comprised the vast majority of respondents and 90% of all respondents selected option "c," primarily based on confusion regarding insurance coverage, the amount of the prescription copay, and how to use their medications, as well as the stress and inconvenience of waiting in lines, their prescription not being ready, and the blaring of horns in the drive-thru lane.

Astute CVS Health executives recognized that the polling results identified an even more important implication and vulnerability for the company. CVS was the original name for the company, and "Health" was added many years later, long after company executives had abandoned any interest, commitment, or pretense to the service, health, and welfare of customers so that the company could focus exclusively on revenues and profits. Could the inclusion of the word "Health" in the company's official name be considered a misrepresentation and violation of the False Claims Act? In consultation with legal counsel at sister company Dewey, Cheatem, & Howe, it was decided that the existing name was a liability risk and should be changed.

The executives had also been shocked to learn that cyclic vomiting syndrome and its abbreviation CVS were legitimate recognized designations, and offended that so many of their own pharmacists had selected this option as the origin for their company's abbreviation. Accordingly, it was determined that both "Health" and "CVS" had to be changed to designations that could not be misinterpreted or misrepresented by the growing number of critics of the company. A committee was appointed in accordance with the company's DEI mandates which was comprised of employees representing executive and middle-management areas of responsibility, plus linguists, nomenclature experts, and attorneys, but no pharmacists. The committee was divided into two subcommittees, one of which was charged with recommending an alternative to "Health," and a second which was charged with recommending an alternative to "CVS."

The "Health" subcommittee was the first to complete its deliberations and report its recommendation of "Wealth" to the executive group. The recommendation was immediately and enthusiastically endorsed as a designation that captured the goals of the company and executives, would not be misinterpreted or challenged, and required a change of only one letter. It was anticipated that shareholders and Wall Street would also quickly embrace this change. One executive proposed that "Wealth" be printed in gold letters, but the CEO responded that the company's department of creative art should be consulted first.

The "CVS" subcommittee had more of a challenge and some of them were still recovering from learning that the designation had been misrepresented in such sickening and revolting ways as "cyclic vomiting syndrome" and "come visit Satan." They recognized the importance of identifying a designation that would be a radical 180-degree turn from the present one that had been depicted in such a perverse manner. Following lengthy discussions, one subcommittee member asked, "Why not just reverse the letters to SVC? If this is interpreted as an obscure abbreviation for ‘service,' that is all the better, and there is almost no possibility that anyone would think of superior vena cava." They all agreed and presented the recommendation of "SVC" to the executive committee. Although the company's medical director identified "subclavian vein compression" and "slow vital capacity" as possible misinterpretations, it was agreed that there was little risk of that occurring, and the new name of SVC WEALTH was officially adopted, subject to being rubber stamped by the Board of Directors.

As the meeting was approaching the scheduled 3 pm time for adjournment so the executives could leave and get ahead of the heavy traffic in downtown Woonsocket, one participant stated, "I am very hesitant to bring this up but should we also consider the heart that is part of the company's logo?" Some years ago, CVS had hijacked the heart and included it with the company name in its logo as symbolic of a message of life, love, and vitality it wished to convey. More recently, there had been situations in which hearts in the company logo had been defaced. Someone had drawn a thick black line through the center of the heart, apparently to convey a message of a broken heart. The perpetrator had been quickly identified as a rogue ex-CVS pharmacist who had been terminated for not meeting vaccine quotas for 2 consecutive months. Another ex-CVS pharmacist who had been terminated for spending too much time counseling customers in the OTC aisle had been caught covering the hearts in the logo with black paint.

Another meeting participant shared that he had been working late earlier in the week when an elderly member of the maintenance staff had arrived to empty the wastebaskets and polish the furniture in the executive suite. The staff member was humming along with a melody that was softly playing on the office intercom. He told the executive that he had heard the melody on the intercom on numerous occasions but only recently recalled the name of the song as "Hearts of Stone" that was popular in the 1950s. Among the lines of the song he could recall were "Hearts made of stone will never break" and "Hearts of stone will cause you pain."

The CEO stood up and declared, "Enough with the hearts! We will take them out of the logo, too! They never really represented our corporate priorities or ethos, anyway. The heart was placed in the logo by a previous male CEO who wanted us to be viewed as a caring company. But that charade only lasted for several days before it was exposed." "Besides," she continued, "I need to finish writing my book. As you all know, I don't need any money from book sales so I will be donating the proceeds to organizations supporting mental well-being and empowering young women. Current employees, men, and older women are not eligible for this support. Meeting adjourned!"

Responses of the Pharmacy community

Rumors of the plan of CVS to change its name and logo quickly circulated among the national associations representing pharmacists. They snapped into action to establish a coalition to provide a response from all 314 associations (up from just 302 last year). In a rare example of unanimity, they selected the CEO of the American Pharmacists Association to be the spokesperson who, like CVS, had also been mis-identified as the owner of Jersey Mike's Hoagies. He read to the remotely assembled gathering from a prepared brief statement that looked much longer because of the 12 pages of listings of the associations and their CEOs.

"Our associations are puzzled by but stand in support of the decision by CVS Health to change its name to SVC Wealth and delete the heart from its logo. Although we had hoped that the word "Pharmacy" or "Pharmacists" would appear somewhere in the new name, we recognize the importance of wealth and request that consideration be given to paying the membership dues for their approximately 30,000 pharmacists in one or more of our associations. We look forward to a continuing collaboration in which SVC Wealth will provide an even larger number of grants, scholarships, and other gifts to our associations. Last, but not least, we also hope that working conditions for SVC pharmacists will improve, and that fewer errors will occur."

Only Suzy Rosa Rassuh, the Chairman, CEO, and President (CCEOP) of the Hungarian-American Pharmacists Association (HAPA) provided additional comments:

"We have been discussing stress, burnout, moral injury, mental anguish, suicide, second victim syndrome, toxic workplace culture, well-being, resilience, psychotherapy, meditation, and recovery for years. We have conducted surveys, panel discussions, roundtables, consensus conferences, and walkouts, and have arranged for pharmacists to self-assess their moral injury through sophisticated analyses. However, working conditions have only gotten worse! We know what the problem is! We know what the consequences are! We know who the victims are! And we know which individuals and organizations are primarily responsible for this crisis! It is CVS and its leadership, or SVC, or whatever other designation they want to call themselves! They can change their name but they can't hide! NO MORE TALK! IT IS TIME FOR ACTION! CVS/SVC can't be reformed! And with respect to the name change, remember, today is April Fools' Day."

Daniel A. Hussar
April 1, 2024
DanH@pharmacistactivist.com

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