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Mail order pharmacy, part 1

By leigh | May 11, 2013

I wrote this last year. It is still true this year. I have illustrated it with cute kittens, to reduce the stress caused by thinking about dealing with mail-order pharmacies.

< corporate name deleted > is a “pharmacy benefit manager” offering mail-order prescriptions. They are supposed to be convenient for patients.

Like all capitalist health enterprises, they mainly seek to limit and deny care in order to maximize their profits.

One important way for them to do this is by obliging me to call them personally to obtain permission for my patient to keep taking the same medication he has taken for the past ten years, which he has been ordering from < corporate name deleted > for the past several years.

Since I knew from past experience that I would be on the phone for a long time, I spent the time reading what others have said about < corporate name deleted > on the internets (links highlighted below).

2:50 pm, I entered the automated system.

Was asked for lots and lots of information, none of which was understood by robot the first time.

Was obliged to repeat six times that I do not have patient’s special < corporate name deleted > card in front of me – tried various pitches and paces of speech – considered giving fake card number, but didn’t.

Was repeatedly told by robot, “I’m sorry. Please say the member’s identification number.” Wondered how long this could possibly continue.

2:58 pm, Switched to a human.
Asked by human for all the same information about the patient again, with repeated apologies.

Human understood right away that I do not know the member’s identification number.

Prescription data recited by me, repeated by human.

3:05 pm, Human now began entering my info (e.g. phone number, address, repeated spelling of name several times – I have a weird name, I guess – and three separate tries for zip code, which, by 3rd try, human knew by heart).

3:10 pm, Human said, “I’m so sorry,” for 7th time (I began tally after 3rd time), because “I can’t find you in the system.”

3:11 pm, 8th apology. Human also asked how my day was going, whether it was almost the end of the workday for me, noting that it was, after all, Friday.

3:15 pm, Asked for my own information again (phone number, address, spelling of name, memorized zip code), “so I can enter it into the system.”

3:21 pm, Told that < corporate name deleted > would fax a form that must be returned by me within ten days, after which < corporate name deleted > would review the patient’s case, and decide whether to supply the medication that the patient has been using for the past ten years, which he has been ordering from < corporate name deleted > for the past several years.

I was also given a phone number to call if I wanted to register a complaint, and kindly advised to have a great weekend.

The last three times I went through this process, on behalf of two other patients, I was repeatedly told that < corporate name deleted > had already sent me the fax, and would graciously send it again – but I never did receive it.

Meanwhile, I did a little research and discovered that the same medications were much cheaper at our local big-box stores, and those two patients simply transferred all their prescriptions from < corporate name deleted > to those pharmacies instead. Their insurance would only cover a 30-day supply at a time, but they didn’t mind, because they go to that store regularly anyway.

Some drugs are pricey no matter where you go – but in my own personal life I still steer clear of < corporate name deleted >, because they suck so much. For example, I don’t know what this drug costs from < corporate name deleted >, with insurance paying for most of it, but at one of the local big-box stores, paying out of pocket, it is $17.40/month (brand name version = $342.66, boo, hiss).

…Okay, the medicine is sumatriptan. (Brand name, Imitrex.)

I am saying that in some cases, it may cost less to pay out-of-pocket, than to have insurance “cover” the medication. Many patients tell me they paid a $10 co-pay for a medicine that is $4 per month, cash. This is not true for the very spendiest medicines, of course, but it is true for the vast majority of the drugs for which I personally write prescriptions.

I know it is very irritating to listen to doctors whinge about how annoying it is for them to deal with insurance companies of all varieties, including mail order pharmacies that are part of an insurance system.

But a large part of my own annoyance is how obvious, how terribly obvious it is, to those of us who are struggling to deliver the health care to you, the consumer, who already paid for it (through lower wages, since your employer pays through the nose for their part of the insurance, and through the premiums you pay, more and more each year, and through the sizable chunk your insurance declines to pay for and you must pay for yourself)… To us, at least, it is obvious that their main business is to limit and deny that care.

To you, it may appear that your doctor, or their helper, is an incompetent boob who can’t manage to get through a simple phone call without getting mad.

But to us, it’s obvious that we’re being made the fall guy for heartless capital, not to mention wasting hours every week, trying – often unsuccessfully – to get you what we want you to have, for your health and safety.

Down with < corporate name deleted >, I say! Down with them and all their friends!

…Okay, the corporate name is Medco.

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