By MATTHEW HOLT
As we speak we’re going to have enjoyable with present and inform. I’m going to indicate you ways a little bit nook of American well being care is making my life as a shopper worse and costlier–hopefully somebody can inform me why.
The forged members are: me, my MD, the (type of) impartial pharmacy that delivers, Alto, and my insurer Blue Defend of California and its PBM CVS Caremark, which additionally owns a mail order pharmacy.
The temporary backstory: For some years my physician has been whining about my excessive ldl cholesterol, and some years again I went on a statin referred to as Rosuvastatin Calcium. Older readers could bear in mind Jean Luc Picard himself promoting the branded model Crestor, but it surely’s been off patent for a few decade. About 50 million People now take a statin, virtually all of them a generic, together with many 60 12 months outdated males like me. My ldl cholesterol has come down, however my MD advised me it might come down extra, so just a few months in the past we boosted the dose to 40mg from 20mg.
Till lately I’d been insured by BCBS Massachusetts, and also you would possibly recall a little bit over a 12 months in the past I wrote a piece on THCB in regards to the enjoyable and video games available making an attempt to determine what their PBM (CVS Caremark) was doing with the pricing of my child’s ADHD treatment. However they’d by no means messed with my treatment as my statins are low cost. A minimum of I assumed they have been. In reality as lately as April final 12 months, they have been free. You’ll be able to see the worth from the supply from Alto Pharmacy beneath.
How BCBS Mass got here up with $0.00 as the worth I pay I don’t know, however presumably they assume it’s a great factor to have me on statins within the hope I don’t have an (costly) coronary heart assault as a substitute.
Then for some cause my value for the statin later the identical 12 months went as much as $23. Not $0 however at $8 a month probably not price making a fuss about.
On the finish of the 12 months, COBRA expired and I went to purchase insurance coverage on the California alternate. And to be able to maintain entry to my household’s docs at One Medical, I selected the one plan they have been in, the Blue Defend of California HMO.
My subsequent 90 day provide was the primary one which went from 20mg to 40mg, but it surely’s nonetheless a standard generic. Blue Defend of California additionally makes use of CVS Caremark (though it’s been talking a good game of ditching CVS Caremark and setting up its own PBM) and the price at Alto barely budged. Now it was $28.
What occurred subsequent: So all was going usually till late final week when my subsequent 90 provide was delivered. Besides it wasn’t. Alto delivered me a 30 day provide and charged me $19.
Cling on, why change a 90 day provide for a med I’m speculated to take day-after-day ceaselessly for a 30 day one?
I enquire to Alto’s message system they usually blamed Blue Defend.
And naturally Alto now could be solely allowed to fill my different meds on a 30 day cadence additionally.
So mainly it appears like Blue Defend’s mail order service is enjoying hardball. They need me to maneuver my 90 day order to them.
A diversion: Earlier than I try this, it could be price what it prices for money. GoodRx’s least expensive charge is about $18 for a 90 day provide. However after all I’ve to drive to select it up, whereas Alto delivers. I’ll pay $10 extra each 3 months for that.
Enjoyable with customer support: So now to serve the great readers of THCB and since I’m bloody minded in regards to the shopper expertise, I resolve to seek out out from Blue Defend what is definitely occurring. (I additionally stay tweeted the enjoyable and video games)
“I’m on with @BlueShieldCA maintain music. Let’s see how they do as compared with South Park….” (I’m certain you’ve seen the South Park version by now)
The reply will not be effectively. BCBS Mass had a chat operate, if no AI. Blue Defend of California has a cellphone line. With voice recognition that, effectively, doesn’t work.
After they ask me my date of start and are satisfied my sixty is a fifty. It’s additionally obvious their voice recognition can not perceive “NO” and but they’re so assured it’s excellent they gained’t let me “Press 1 for sure or 2 for no”. However they’re completely satisfied to inform me that descriptions of advantages are usually not a assure of cost & I ought to schedule a wellness go to–regardless that they acknowledge my cellphone quantity they usually’ve already paid for a wellness go to this calendar 12 months. There’s over three minutes of irrelevant messaging, then 90 seconds of additional identification which doesn’t work as a result of it nonetheless can’t inform my start 12 months.
Blue Defend the tech chief: In its public pronouncements Blue Defend is claiming that it’s updating its tech. In reality Exec VP Peter Lengthy has been boasting about it on Linkedin
The common tweet reader could recall them earlier this 12 months sending me 5 similar letters to inform me that I had modified my PCP, which I had advised them within the first place!
Chances are you’ll surmise that I’m not seeing their tech upgrades as bettering my expertise…but.
So again to my statin. You’ll recall that it appears Blue Defend transformed a upkeep statin I had been receiving from Alto Pharmacy to 30 days with out telling me, and with out permitting Alto to fill it for 90 days. Presumably they need to transfer this to their PBM/pharmacy to maintain the revenue.
My price for 90 days was $28, for 30 days $19. So if I stored it with Alto my annual price would go from round $112 to $228. So if I did nothing somebody could be maintaining the additional $116.
Chances are you’ll recall that I used to be on maintain. An agent got here on the road ultimately and advised me I’ve to talk to the pharmacy. After being on the decision for 22 minutes, somebody got here on and their opening phrases have been to inform me that Blue Defend, “not us”, insists that I get this drug by way of mail order. So who’re “you” I ask? “CVS Caremark” they are saying. So “how do I get my Rx by way of CVS Caremark” I ask? You are able to do it on the Blue Defend web site. And in the event you hunt round a bit you’ll be able to.
So I gamely click on through on the Blue Defend web site, by way of to the CVS Caremark sub-site for Blue Defend, register with my ID quantity on the CVS Caremark web site and get this:
This has taken me 26 minutes on the decision, (not counting the primary 5 min name that dropped), 10 minutes screwing round on the @blueshield & @CVSHealth web site, and naturally the 2 websites can’t talk…they usually invite me to name again.
However as a result of I’m a sucker for punishment I strive once more, and see if I can determine another means within the Blue Defend web site. There I discover a drug pricing instrument.
I want to know the price to me of transferring to the CVS Mail order. The instrument is aware of the medication I’m on! I ask it for the worth of my statin and it tells me it’s $19 for 30 days provide–the each value Alto charged me. It additionally tells me I can get 90 days by way of mail order!
So I click on on that hyperlink and now it sends me to @cvspharmacy (once more) , which lets me click on on a current Rx I’ve stuffed (I assume primarily based on the declare from February) to see what the pricing is by way of mail order.
And naturally you’ll be able to guess what the response is.
The reply is that 90 days provide will not be obtainable in a retailer and apparently neither is 90 days provide obtainable by way of mail order. And for this fabulous expertise they need to cease me utilizing Alto Pharmacy. Presumably they need me to drive my physician’s workplace to resubmit the Rx to CVS mail order.
If you’re nonetheless maintaining rating, someplace between Blue Defend and CVS Caremark, for a upkeep drug that they need to encourage me to be on (I assume), which prices them virtually nothing to accumulate, they need me to alter pharmacy and/or hassle my physician.
We nonetheless gained’t know if it really works, and for that matter it’s uncertain who will get the additional $116 if I’m going again to 30 days at Alto.
And naturally it could be simpler and cheaper for me to pay the $11 + transport it could price me to buy 90 days supply at Mark Cuban’s Cost Plus drugs. However then it wouldn’t depend in opposition to my deductible, and my insurer, who presumably is meant to care about my well being and my Rx adherence, gained’t know what medication I’m on.
I hope you’ve loved this little journey by way of this obscure nook of the American well being care system. Bonus factors in the event you can clarify why anybody would need to undergo this, or what the hell Blue Defend or CVS Caremark are gaining for making me do it.
