Pharmacists Working in PBMs/Managed Care are Scumbags #RuiningTheProfession

[BMBiology]

But obviously we have let them grow so powerful, we must pick up the pieces.

There you go. Just like how Walmarts destroyed all of the mom and pop retail stores. The same thing is happening to independent pharmacies. You may not like the way Walmarts conducts its business but you can't argue with the fact that they offer value.

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[All4MyDaughter]

Hahaha, again, you are comparing 2 different things. Like I said, my books are open to them. have been audited numerous times, including purchasing and what i paid for it, Again Darling, the pharmacy business has been so exploited, your argument is weak and baseless. Our business is and every pharmacy business is transparent, otherwise how would a PBM to pay me 5 dollars above my cost? You cant compare my pharmacy to the pharmacy down the street. We are talking about the transparency of PBMs.

And taking Medicare or Medicaid is NOT a deal. My books and purchasing is open to them. Rebates are reported, so again, we are widely transparent.

Yep. They can (and do) come in and look at EVERYTHING. But they won't tell us how they calculate the MAC because it's proprietary. I am so accustomed to verifying scripts for < $2 profit that I don't even notice that much anymore. But the bigger losses make me pause, because I know the owner is tracking them too.

Our state legislature had a hearing where the scumbag (I mean executive) from MEDCO swore up and down that they NEVER EVER NEVER NO WAY ever paid a pharmacy in Kentucky anything less than what it cost to buy the drug. (Never mind that it costs more to fill an RX than just buying the drug...) He swore. He was UNDER OATH. Then, one senator asked every independent pharmacist in the room who had ever lost money on a below cost reimbursement from MEDCO to stand. It was telling.

 

[BMBiology]

And taking Medicare or Medicaid is NOT a deal. My books and purchasing is open to them. Rebates are reported, so again, we are widely transparent.

I don't care that your books are open to your auditors. Are you willing to show your books to your competitors down the street from your pharmacy? That's what you are asking the PBMs to do.

 

[BMBiology]

Our state legislature had a hearing where the scumbag (I mean executive) from MEDCO swore up and down that they NEVER EVER NEVER NO WAY ever paid a pharmacy in Kentucky anything less than what it cost to buy the drug. (Never mind that it costs more to fill an RX than just buying the drug...) He swore. He was UNDER OATH. Then, one senator asked every independent pharmacist in the room who had ever lost money on a below cost reimbursement from MEDCO to stand. It was telling.

This doesn't make sense. If I am a dentist and it cost me $100 to treat a patient's cavity, then the insurance company must therefore pay me > $100? If it cost another dentist down the street $85 to treat a patient's cavity, why should the insurance company keep on overpaying me?

I don't care too much about insurance companies but we all know the additional cost will be passed on to the patients.

 

[All4MyDaughter]

I don't care that your books are open to your auditors. Are you willing to show your books to your competitors down the street from your pharmacy? That's what you are asking the PBMs to do.

If I'm following your (il)logic, you think PBMs should be free from transparency in their dealings with Doctor M because they are his competitor? But it's fine for them to require Doctor M to put up with their intrusive audits and getting in all his business. Sure, that sounds legit.

 

[Doctor M]

There you go. Just like how Walmarts destroyed all of the mom and pop retail stores. The same thing is happening to independent pharmacies. You may not like the way Walmarts conducts its business but you can't argue with the fact that they offer value.

well, they did destroy it. and walmart does offer value. at the exploitation of many many workers. i dont shop at walmart, and never will. I dont argue the fact that they are cheap, but they are the root of exploitation and greed. i never never will shop there. i have other options.
Yes, walmart offers value (exploitation) and yes their $4 generic list destroyed many mom and pops, and NO, the PBMs offer NO value. The only thing i can think that they offer employers is the fact that they audit the crap out of indys and promise the employer a percentage to be returned to them after the audit. Other than that, i see NO benefit whatsoever, just GREED.

 

[All4MyDaughter]

This doesn't make sense. If I am a dentist and it cost me $100 to treat a patient's cavity, then the insurance company must therefore pay me > $100? If it cost another dentist down the street $85 to treat a patient's cavity, why should the insurance company keep on overpaying me?

You definitely work for a PBM. Or, at least, you should. That is classic PBM Koolaid talk. They just decide by some magical formula how much it costs to buy drugs, and that's what they pay. They won't tell you in advance how much they will reimburse for any given drug product, or where they buy these wonderfully dirt cheap drugs. In the same hearing, an exec from a different company accused the independent pharmacists of Kentucky of being too lazy to look for lower cost drugs... as if we purposefully go out and buy the most expensive thing just for the hell of it.

 

[Doctor M]

I don't care that your books are open to your auditors. Are you willing to show your books to your competitors down the street from your pharmacy? That's what you are asking the PBMs to do.

Im not following your logic at all. You dont make any sense. Why would I open my books to my competitor? You are assuming the PBM is my competitor? again, your logic and argument doesnt make sense.

 

[BMBiology]

The truth is that independent pharmacies cannot compete with CVS, walgreens, walmarts' $4 generic, mail order.

When your cost is higher and you are not as efficient, you will go out of business. It doesn't matter if you are in the pharmacy business or grocery business. You can blame on the PBMs or whoever you want. That's just how things work.

 

[BMBiology]

Im not following your logic at all. You dont make any sense. Why would I open my books to my competitor? You are assuming the PBM is my competitor? again, your logic and argument doesnt make sense.

Not the PBMs. They don't care about your small business. The retails, the independent pharmacies down the street from your pharmacy. I am sure they would like to know how you run your business.

 

[Doctor M]

I don't care that your books are open to your auditors. Are you willing to show your books to your competitors down the street from your pharmacy? That's what you are asking the PBMs to do.

The pharmacy business is transparent. my competitors know what i pay, cause CVS owns a PBM, as did Walgreens. All independents buy at similar prices. We all have similar reimbursements (indys). Again, my books are open, everyones are. Rebates are no secret. But the PBM business is a total secret. Anyway you look at it, its a scam.

 

[All4MyDaughter]

Not the PBMs. They don't care about your small business.

The hell they don't. They care so little they come in and audit out the wazoo as much as they want to. I think you must be drunk or high tonight.

 

[Doctor M]

Not the PBMs. They don't care about your small business. The retails, the independent pharmacies down the street from your pharmacy. I am sure they would like to know how you run your business.

The PBMs do care cause they exploit us. Anywhere there was money made, they come knocking. Again, why does showing my competitors my book matter in this argument? The argument is that PBMs have shady business practices who are making billions and we dont know how they are doing it. Are their practices legit? Legal? We just dont know.

 

[Doctor M]

The truth is that independent pharmacies cannot compete with CVS, walgreens, walmarts' $4 generic, mail order.

When your cost is higher and you are not as efficient, you will go out of business. It doesn't matter if you are in the pharmacy business or grocery business. You can blame on the PBMs or whoever you want. That's just how things work.

HAHAHAHAHA, the $4 list is a joke. All those drugs are so cheap. I compete everyday. Its just getting to the patient and letting them know i match all $4 generics. And CVS and Walgreens prices are a complete joke. lol lol lol Just an FYI

 

[Doctor M]

BMbiology, Your argument is weak at best. The PBMs exploit us cause we let them. The huge chains get audited 1 to twice a year. if at all. They have contracts stating how often they may be audited. If the PBMs can only audit them like that, who else are they gonna audit? And why the hell would Caremark audit CVS? LOL LOL LOL its all a scam and we all fell for it. I liken this to selling poop on the side of the street and claiming it will cure cancer.

 

[All4MyDaughter]

HAHAHAHAHA, the $4 list is a joke. All those drugs are so cheap. I compete everyday. Its just getting to the patient and letting them know i match all $4 generics. Just an FYI

We don't have a $4 list but we have a $12/100 tabs list and it does just fine. Patients come to our pharmacy because we have delivery and curbside service, and because we serve all waiters in less than 15 minutes. We know their names. We special order OTC products for people... try getting Walmart or CVS to do THAT. We counsel on all new scripts and I personally greet every waiter at the cash register after I've verified their meds. It's not even difficult to provide those little extra friendly services.

 

[Doctor M]

We don't have a $4 list but we have a $12/100 tabs list and it does just fine. Patients come to our pharmacy because we have delivery and curbside service, and because we serve all waiters in less than 15 minutes. We know their names. We special order OTC products for people... try getting Walmart or CVS to do THAT. We counsel on all new scripts and I personally greet every waiter at the cash register after I've verified their meds. It's not even difficult to provide those little extra friendly services.

 

[BMBiology]

BMbiology, Your argument is weak at best. The PBMs exploit us cause we let them. The huge chains get audited 1 to twice a year. if at all. They have contracts stating how often they may be audited. If the PBMs can only audit them like that, who else are they gonna audit? And why the hell would Caremark audit CVS? LOL LOL LOL its all a scam and we all fell for it. I liken this to selling poop on the side of the street and claiming it will cure cancer.

Look, I am all for independent pharmacies. It is good for you and good for the pharmacy profession. But before you expect another business to open its books to the public, I think it is only fair that you do the same.

The big fish will always eat the small fish. Is it fair that the PBMs are offering you less reimbursement than the chains because you don't have the buying power? Maybe not but that rule doesn't just apply to pharmacy, it applies to every aspect of the our economy.

 

[Momrowgal]

Section 6005 of the Affordable Care Act will require all PBMs that do business with Medicare or the health insurance exchanges to submit documentation on their prices and "spread" to CMS. This is supposed to go into effect in Jan. 2014.

 

[SHC1984]

This doesn't make sense. If I am a dentist and it cost me $100 to treat a patient's cavity, then the insurance company must therefore pay me > $100? If it cost another dentist down the street $85 to treat a patient's cavity, why should the insurance company keep on overpaying me?

I don't care too much about insurance companies but we all know the additional cost will be passed on to the patients.

You get what you pay for PERIOD. ALWAYS AND FOREVER.

If you want to pay less you will get a much crappier product or service.

The cavity filling or drug will be crappier if you are cheap and want to pay less.


Let me repeat again...you get what you pay for. If you are cheap you will get a ****ty product or service.

 

[hereticmnk]

Medicare part D plans are NOT a single payer system.

Also, ACA isn't going to hurt managed care organizations. Who do you think is going to benefit from requiring people to buy insurance?

I thought that the there might be an initial spike after the ACA adds a few million into the healthcare system followed by the slow decline.

So any insurance company can manage all aspects except rx coverage because it's too complex?

That's quite the joke

Division of labor.. carve outs.. yes

 

[hereticmnk]

If PBMs do not offer any value, then why are they still here? The free market would have gotten rid of them by now. Because they can do things cheaper and more efficient. They cut cost. Insurance companies love them. They are not going anywhere.

You are assuming that free market takes care of everything. There would be no need for regulation. Secondly, PBM's do not operate within a free market system. There is lack of information and they are exempt from antitrust laws. They already defy many fundamental characteristics of a free market enterprise.

 

[hereticmnk]

Fair enough. You own a pharmacy. Lets have transparency in your business and the deals you made. Why would any business let their competitors know about their affairs?

Really? Is it opened to your competitors down the street from your pharmacy as well?

Thats where the problem lies. The conflict of interest. You have a responsibility to find the lowest price for the contractor while you also are capable of dispensing medications. Why would you not try to squeeze every penny out of your competition to give yourself the competitive advantage.

One sentance in the law is all that will take to convince me that PBM's are useful:

"Pharmacy benefits managers have a fiduciary responsibility towards their contractors"


The transparency is god-awful with these PBM's..

 

[hereticmnk]

Section 6005 of the Affordable Care Act will require all PBMs that do business with Medicare or the health insurance exchanges to submit documentation on their prices and "spread" to CMS. This is supposed to go into effect in Jan. 2014.

Beautiful

Sorry for the multiple posts guys

 

[Doctor M]

Look, I am all for independent pharmacies. It is good for you and good for the pharmacy profession. But before you expect another business to open its books to the public, I think it is only fair that you do the same.

The big fish will always eat the small fish. Is it fair that the PBMs are offering you less reimbursement than the chains because you don't have the buying power? Maybe not but that rule doesn't just apply to pharmacy, it applies to every aspect of the our economy.

Thats what your are not getting. Why should the PBMs offer me less? They arent buying the drug. all they are doing is reimbursing me for the drug at a set rate. Why are the rates different? What does my buying power have to do with anything other than me making more if i buy it at a cheaper price???? We provide better service, more service and whether i but the drug at X dollars or Y dollars should not mean a damn thing. Again, illogical.

 

[Doctor M]

This doesn't make sense. If I am a dentist and it cost me $100 to treat a patient's cavity, then the insurance company must therefore pay me > $100? If it cost another dentist down the street $85 to treat a patient's cavity, why should the insurance company keep on overpaying me?

I don't care too much about insurance companies but we all know the additional cost will be passed on to the patients.

because that is what the provider believes he should be paid.

 

[Doctor M]

I truly believe if we cut the middlemen out, and charge a reasonable amount for our services, the cost of Health insurance will level out. Why are we paying billions of dollars to the middlemen???I would be perfectly content making what i make now without the middlemen. at least i wouldnt be losing thousands to audits anymore.

 

[WVUPharm2007]

We special order OTC products for people... try getting Walmart or CVS to do THAT.

We special order OTC medications for people all the time. If my 'Sup found out that I refused to do it, I'd probably get reamed.

 

[joetrisman]

We special order OTC medications for people all the time. If my 'Sup found out that I refused to do it, I'd probably get reamed.

Ditto at Wags. Although our system really has no good way to make notes about such things that aren't related to Rxs

 

[MountainPharmD]

We special order OTC medications for people all the time. If my 'Sup found out that I refused to do it, I'd probably get reamed.

What are you talking about?!?!? Its retail pharmacy...the customer is always right and we always kiss their ass.....Shoot, you'd get fired if a customer asks you to bend over so they could take advantage of you and you refused.

 

[All4MyDaughter]

Ditto at Wags. Although our system really has no good way to make notes about such things that aren't related to Rxs

Not every Wags in this market makes a habit of it, I'll tell ya that. My sister had trouble getting someone to come out of the pharmacy and help her locate a product that was on the shelf in a odd place. She was told, "If it's not out there, we don't have it." Not naming any names or store numbers, though.

 

[joetrisman]

What are you talking about?!?!? Its retail pharmacy...the customer is always right and we always kiss their ass.....Shoot, you'd get fired if a customer asks you to bend over so they could take advantage of you and you refused.

Sometimes I wonder where that line finally is drawn with customer service when working at Wags

 

[joetrisman]

Not every Wags in this market makes a habit of it, I'll tell ya that. My sister had trouble getting someone to come out of the pharmacy and help her locate a product that was on the shelf in a odd place. She was told, "If it's not out there, we don't have it." Not naming any names or store numbers, though.

Yeah, the variability between how stores are run drives me crazy and therefore I tend to avoid picking up shifts when asked at other stores. Some managers set the pace to be patient centric, some set the pace to be metrics centric.

 

[MountainPharmD]

I truly believe if we cut the middlemen out, and charge a reasonable amount for our services, the cost of Health insurance will level out. Why are we paying billions of dollars to the middlemen???I would be perfectly content making what i make now without the middlemen. at least i wouldnt be losing thousands to audits anymore.

You can't cut out one middleman and expect it to save the world. When you think about it the entire insurance industry is a middleman. Cutting out the PBM middleman wouldn't do a thing...The billions of dollars would just go to some other huge corporate entity. Why do you think there is a big push for PBM's to be transparent? It isn't to help the little guy like you. PBM's could be transpart as glass and you would still be getting screwed. The government and the insurance companies want transparency so they can get more of the money. Plan and simple it is profit motivated.

Doctor M you want to blame the PBM industry for audits as if they are the only entitiy in heathcare that conducts them. My friend if you want to see a real audit wait until 2014 when all the new health care regulations hit. You ain't seen nothing yet until you have OIG inspectiors crawling up you ass. You will wish for the days where all you had to worry about was a Caremark audit.

What you are proposing above sounds simple but would require esentially getting rid of the health insurance system in the United States. Its a nice thought but it will never happen. There are many problems with healthcare in the United States, PBM's being one small part. To suggest PBM's are the only or the biggest problem is naive and uniformed.

 

[MountainPharmD]

Not every Wags in this market makes a habit of it, I'll tell ya that. My sister had trouble getting someone to come out of the pharmacy and help her locate a product that was on the shelf in a odd place. She was told, "If it's not out there, we don't have it." Not naming any names or store numbers, though.

What?!?!!? I saw a TV comercial where a Walgreens pharmacist was running over the tops of shelves to help and old lady pick out a laxitive. Are you trying to tell me something I saw on TV is not true?

 

[npage148]

You can't cut out one middleman and expect it to save the world. When you think about it the entire insurance industry is a middleman. Cutting out the PBM middleman wouldn't do a thing.

It would kill the jobs of a bunch of greedy *******s who serve no purpose but to screw people. I think that's a good thing.

 

[MountainPharmD]

Sometimes I wonder where that line finally is drawn with customer service when working at Wags

There is no line. This is one of the many reason I final got fed up with retail and left. At Kroger we were expected to take abuse from customers and got no support from management. It didn't matter if a customer came up and used every curse word ever spoken. We were expected to take it and smile because they were getting prescriptions filled and by God we didn't want to lose any prescriptions.

I was, swear to God, told by my pharmacy supervisor that when people get angry, yell, curse and threaten us that it is our fault for not being understanding and taking their feelings into account because they probably just had a bad day. This was said after an idiot customer went off on two of my techs and my assistant pharmacy manager because he wanted a copy of his wife's medical expense statement and they would not give it to him because it is a HIPAA violation to give out her infomation without her consent. Turns out this idiot was the HIPAA privacy officer at a hospital down the road from us. Really?!?! The HIPAA privacy officer and you didn't know we could not give out your wife's info without her conset? Of course this jackass complained all the way to high hell about how "badly" he was treated. My pharmacy supervisor called him and apologized and told me I had to give him a $50 gift card next time he was in the store. That was the end of retail pharmacy for me.

 

[MountainPharmD]

It would kill the jobs of a bunch of greedy *******s who serve no purpose but to screw people. I think that's a good thing.

How do you figure they are screwing people? Give me some specific examples of how the PBM's are screwing people. Not your anecdotal we get audited all the time or the rebate argument. Give me real concrete examples of the PBM's actually screwing people.

If there weren't PBM's who do you think would manage the prescription benefit of a members health insurance plan? The insureance companies would have in house pharmacy benefit management departments. Pharmacy benefit management would be okay if the insurance companies had in house PBM departments to handle it verse a stand alone PBM?

I hate to break it to you but prescription drugs are a huge expense to insurance companies. A stand alone PBM or an in house PBM department will always be in place to manage the prescription drug benefit. Not doing so would and billions of dollars to the cost of health insurance.

 

[npage148]

Manditory mail order screws people. Use the PBMs mail order pharmacy or pay more if they even let you go to a community pharmacy. It serves no purpose other than to eliminate patient choice

And it's dangerous. Patients love the idea of temperature and shock sensitive meds being sent USPS with no guarantee of a maintained cold chain

 

[Doctor M]

How do you figure they are screwing people? Give me some specific examples of how the PBM's are screwing people. Not your anecdotal we get audited all the time or the rebate argument. Give me real concrete examples of the PBM's actually screwing people.

If there weren't PBM's who do you think would manage the prescription benefit of a members health insurance plan? The insureance companies would have in house pharmacy benefit management departments. Pharmacy benefit management would be okay if the insurance companies had in house PBM departments to handle it verse a stand alone PBM?

I hate to break it to you but prescription drugs are a huge expense to insurance companies. A stand alone PBM or an in house PBM department will always be in place to manage the prescription drug benefit. Not doing so would and billions of dollars to the cost of health insurance.

I disgree for all the reasons i have written. PBMs may have had a reason to be here 20 years ago, but today, it needs to change. I would like to see them gone, but obviously that will not happen. I am content with tighter regulation so as NOT to see them abuse small businesses and the like. And I am very aware of what Obamacare is going to do. I am ready for the OIG...

 

[All4MyDaughter]

Manditory mail order screws people. Use the PBMs mail order pharmacy or pay more if they even let you go to a community pharmacy. It serves no purpose other than to eliminate patient choice

And it's dangerous. Patients love the idea of temperature and shock sensitive meds being sent USPS with no guarantee of a maintained cold chain

Right! My own personal PBM (love ya, MEDCO) put my Apidra insulin into "mandatory mail order" status and didn't tell me or send a letter (which they always have in the past). I didn't find out until I went to the local pharmacy to pick it up and the claim was denied. I called and was told that there was no way to override it, even for one vial. Also that they would need at least a week to get the insulin to me by mail for the first fill. Mind you, this was in July when we were having temps in the 100+ range. I asked them what they thought I should do if I couldn't pay the cash price, and since they could not supply this essential med in a reasonable time and their suggestion was to GO TO THE EMERGENCY ROOM and "see if they will give you some insulin." WHAT?!?! Also, I'm sure United Healthcare would love paying the bill for that unneeded ER visit. Idiots.

 

[MountainPharmD]

I disgree for all the reasons i have written. PBMs may have had a reason to be here 20 years ago, but today, it needs to change. I would like to see them gone, but obviously that will not happen. I am content with tighter regulation so as NOT to see them abuse small businesses and the like. And I am very aware of what Obamacare is going to do. I am ready for the OIG...

I am glad you are ready for OIG. My wife is the Audit Billing and Compliance Manager for one of the biggest hospitals in Texas. On the hospital side it is going to be ugly! I do not think anyone is really prepared for what is about to happen.

Doctor M, if PBM's had a reason to be here 20 years ago what has changed that they are no longer needed today? Things certainly haven't gotten simpler. Prescription drugs are such a big money now someone has to manage it or it will consume everything. If not PBM's then who?

How are they abusing small businesses?

 

[All4MyDaughter]

I am glad you are ready for OIG. My wife is the Audit Billing and Compliance Manager for one of the biggest hospitals in Texas. On the hospital side it is going to be ugly! I do not think anyone is really prepared for what is about to happen.

Doctor M, if PBM's had a reason to be here 20 years ago what has changed that they are no longer needed today? Things certainly haven't gotten simpler. Prescription drugs are such a big money now someone has to manage it or it will consume everything. If not PBM's then who?

How are they abusing small businesses?

1. Mystery MAC pricing that somehow often ends up below what we can actually buy the drug for.
2. Audits of extremely picky, very silly stuff that isn't illegal and doesn't affect patient care, but allows them to take back paid claims.
3. Forcing our customers into mandatory mail order and then expecting us to cover their asses when they mess up and don't get the patient's drugs to them on time.
4. Taking forever to pay claims just because they can.

 

[MountainPharmD]

Manditory mail order screws people. Use the PBMs mail order pharmacy or pay more if they even let you go to a community pharmacy. It serves no purpose other than to eliminate patient choice

And it's dangerous. Patients love the idea of temperature and shock sensitive meds being sent USPS with no guarantee of a maintained cold chain

Not at Caremark buddy! 90 days can be filled at a CVS for the mail order co-pay!

I am not aware of any shock sensitive medications. Nitroglycerin doesn't explode if you shake it!

I am sure patients would love to know how the temperature sensitive medications are treated at thier local pharmacy.

 

[MountainPharmD]

1. Mystery MAC pricing that somehow often ends up below what we can actually buy the drug for.
2. Audits of extremely picky, very silly stuff that isn't illegal and doesn't affect patient care, but allows them to take back paid claims.
3. Forcing our customers into mandatory mail order and then expecting us to cover their asses when they mess up and don't get the patient's drugs to them on time.
4. Taking forever to pay claims just because they can.

All not unique to PBM's. What you are describing is an insurance industry problem. Just wait until 2014 when the government and OIG gets into the game.

You should hear some of the stories from the hospital side of auditing.

 

[All4MyDaughter]

Not at Caremark buddy! 90 days can be filled at a CVS for the mail order co-pay!

I am not aware of any shock sensitive medications. Nitroglycerin doesn't explode if you shake it!

I am sure patients would love to know how the temperature sensitive medications are treated at thier local pharmacy.

Since I work at my local pharmacy, I can verify that my Apidra is taken from the refrigerated tote and put in the refrigerator right away. And even if we left it sitting out all damn day, it's still not 105 degrees in our pharmacy like it is outside. When I'm working, it's more like 65 and the techs have on hoodies... but I digress.

I hate getting meds through the mail. But I have to, for several of my RXs. It's like a little scavenger hunt, trying to figure out where UPS has hidden my stuff when I come home at the end of a long day. I just don't want to deal with that for my insulin.

 

[npage148]

Not at Caremark buddy! 90 days can be filled at a CVS for the mail order co-pay!

I am not aware of any shock sensitive medications. Nitroglycerin doesn't explode if you shake it!

I am sure patients would love to know how the temperature sensitive medications are treated at thier local pharmacy.

Oh yeah, go to cvs or mail order. That's antitrust level crap right there.

And for shock sensitive, protein therapeutics LOVE to be shaken and agitated. Which are what PBMs love to require mail order on the most

 

[All4MyDaughter]

All not unique to PBM's. What you are describing is an insurance industry problem. Just wait until 2014 when the government and OIG gets into the game.

You should hear some of the stories from the hospital side of auditing.

So because there is a bigger, meaner, uglier Boogeyman hiding in the wings, waiting to attack, that makes PBM abuses OK? You asked how PBMs abuse small business and I told you... telling me that something worse is coming doesn't make it any better, ya know.

 

[npage148]

Right! My own personal PBM (love ya, MEDCO) put my Apidra insulin into "mandatory mail order" status and didn't tell me or send a letter (which they always have in the past). I didn't find out until I went to the local pharmacy to pick it up and the claim was denied. I called and was told that there was no way to override it, even for one vial. Also that they would need at least a week to get the insulin to me by mail for the first fill. Mind you, this was in July when we were having temps in the 100+ range. I asked them what they thought I should do if I couldn't pay the cash price, and since they could not supply this essential med in a reasonable time and their suggestion was to GO TO THE EMERGENCY ROOM and "see if they will give you some insulin." WHAT?!?! Also, I'm sure United Healthcare would love paying the bill for that unneeded ER visit. Idiots.

I've seen them do that to multiple patients. Cant pay $100 because we are to amoral to provide proper care? Go to the ER! They must figure that if they kill the patient it's the ultimate cost saving mechanism

 

[All4MyDaughter]

I've seen them do that to multiple patients. Cant pay $100 because we are to amoral to provide proper care? Go to the ER! They must figure that if they kill the patient it's the ultimate cost saving mechanism

And (not) coincidentally that shifts the cost off of the PBM side of the house and back onto the health insurance/plan sponsor. We actually reported that one to the complaints officer for my husband's company.

Another thing I love... when someone shows up in the pharmacy and I haven't seen them for 6 months because they had to go to mail order and for whatever reason, mail order has screwed up and they need something. One lady was actually told by a MEDCO rep to go to her local pharmacy and "see if we would give her" an Advair because they were behind in shipping it to her. We had no valid RX on file and I called the mail order facility to transfer the script to me and they refused. This was 5:30 PM on a Friday and the physician wasn't around either. That patient probably ended up in the ER.