Better for Who?

Ask any senior citizen about his/her prescription medication needs and you will be presented with a list of monthly medicines that they are currently using to treat whatever ails them.  Outpatient prescription drugs are NOT covered by Medicare.  For those who have supplemental insurance plans, many of them are able to offset the cost of these monthly prescriptions.  Others, not so lucky.  Whether or not you think you are paying for these, YOU ARE.  As the costs for insurance companies rise, so do the premiums.  After all, they must recoup the loss somehow.

This brings me to my experience with Express Scripts.  Let me first say that I am not a fan.  Oh, I have been given the standard ad line of how it is so easy to have your prescriptions mailed directly to you at home every three months rather than have to go to the pharmacy once per month.  But I am also old enough to remember the talks about prescription safety about getting all of your prescriptions from the same pharmacy so that they are able to flag the potential drug interactions and contraindications.  I have nothing against anyone earning a living.  But I prefer to have my medical decisions made by someone trained in pharmacology as opposed to a very astute clerk.

For those readers who are not familiar, Express Scripts is a contracted company that mail orders maintenance prescriptions to insured subscribers.  Companies claim that the advantage of this is to realize a savings. But in the same breath, they insist that it is better for “YOU” the consumer.  If you are using a name brand or NON-generic drug as routine maintenance, your insurance provider will insist that you go through Express Scripts to obtain it.  Do that or pay for it yourself.  They will not reimburse you.  For those everyday occurrences such as an antibiotic for a seasonal cold, etc., those medicines can still be obtained (and covered by insurance) from your local pharmacy.

In the interest of cost effectiveness, Express Scripts insists that you obtain your maintenance prescriptions in bulk (3-month supplies) which they ship to you via USPS.  Taking the conversation around the postal service out of this writing, let’s just focus on the actual dealing with Express Scripts. 

As mentioned up front, the largest consumers of maintenance prescription drugs are seniors; Americans who are now on fixed incomes.  The insistence of Express Scripts for consumers to purchase 90-day supplies of these drugs means that the cost is XXX times three (for a three-month supply).  For those who have modest incomes from social security only, this can be difficult.  Also, and this is my biggest problem with the concept, you are buying 90 days supply of medicine that your physician can change at any given moment for any number of reasons.  So now you have what is left of the 90-day supply and you have to purchase yet something else.  That original prescription is useless. You cannot return it (which I understand).  Technically, you are not supposed to give it away AND you cannot flush it down the toilet. 

My personal experience with this was nothing short of a disaster.  My first problem was with diabetes medicine that my husband was prescribed and needed.  As we were purchasing non-generic, we were mandated to have this shipped to us directly in three month supply.  We did that.  At the time I was working out of town.  My husband phoned me from home in a panic stating that he was down to his last pill and nothing had come.  I phoned Express Scripts to inquire and they apologize profusely.  Our card on file had expired so they simply did not ship the prescription.  No contact of any kind – no follow-up phone call, NOTHING.  Their solution was to have me go to the local pharmacy (the one they took our business from) and have them fill a 7-day supply for us to “tide us over” until they could ship the order.  Really?  So, now it’s okay for us to patronize them?  We then switched to generic and filled all future prescriptions locally.

Sadly, this is not the worst of it.  My husband was diagnosed with Lung Cancer.  He endured many a procedure in the name of trying to help save his life.  One of the procedures consisted of a needle being inserted into his chest cavity.  For whatever reason, this resulted in fixing the initial issue but caused him to develop A-fib.  A very expensive medicine to regulate his heart rhythm was prescribed.  We were told that we could fill this prescription locally for three months but after that it would have to be filled on line.   He didn’t have A-fib.  It happened because of the procedure.  The medicine did its job and the A-fib was no longer evident by the third month.  The prescription was discontinued.  That was in May.  By September, another procedure was done which resulted in the A-fib returning.  The physician gave us a prescription which we took to the pharmacy.  I waited in the store for the medicine.  The pharmacist informed me that the insurance was denying it because we were not getting it by mail.  I was livid.  I phoned the company immediately from the store and informed them that the prescription had been discontinued after the first three months as it was deemed unwarranted, but that another procedure had caused this to happen again and it was therefore necessary now.  The woman actually said to me, “Well, if you would have kept filling it anyway you would have it now!”   What went through my head was “Are you fucking kidding me?” But what I said to her was, “May I have your full name please?”  When she asked why I simply told her that I intended to seek legal representation and I wanted to be sure to get her full name for the suit.  I was put on hold and after about 90 seconds she returned to tell me that the prescription would be honored by them for the local pharmacy to fill.  Imagine that.

This same level of inefficiency is utilized in the name of making it better for the patient by Medicaid as well.  In a day when costs are on their own out of control, one as to wonder why simple cost cutting measures are not being sought out and implemented.  The waste is staggering.

As for Express Scripts, if you have had success using their system and find no fault, I am happy for you.  But from my experience and interactions with others I have spoken to personally, it is a system that could use refinement.  Buyer Beware!!!


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