CVS Specialty is especially stupid..

[farmadiazepine]

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I don't know who remembers their HIV regimens or not, but after working in a pharmacy that dispenses 25% HIV medicatons, I pretty much recognize what's right and wrong, or what's unusual, or what's for a patient who is not receiving HIV drugs for the first time.

I just want to share an example of how so called "specialty" pharmacies are really not special at all. "Specialty" is just another term for preferred pharmacy in an insurance carrier's network. These pharmacies simply steer high cost, but the most profitable prescriptions to their own in house pharmacies. They are not doing anything special at all.

Today, a patient needed refills on HIV medications. Truvada, Intelence, Prezista, and Norvir. We run everything through to get a rejection of not appropriate at our location and must fill at specialty. I call CVS/Caremark to see if I can get my friends to fill it at their specialty pharmacy. Nope. There is only one specialty pharmacy in network and that pharmacy is CVS!

I don't want to get into details, so long story short, there was a lot of cursing and me forcing dumb as* supervisors at CVS Specialty and CVS Health PBM to get me a fu*king override to dispense the medications to my patient. The reason being:

CVS said they had the patients medications ready to be shipped, but my patient wasn't picking up the phone. I said I'll have the patient call you. The patient calls them and calls me back saying only one medication was ready. I call back CVS Specialty and say, "What do you have ready?" They tell me Prezista. I ask, "Where's the other HIV drugs?". They say they didn't have anything on file or any record of them.

SO WTF?! You are going to tell me you are going to dispense one HIV drug, an unboosted PI to a patient, without even knowing what regimen this patient is on? So then what is so special about a specialty pharmacy if they don't recognize that an HIV patient can't just get Prezista by itself, that there is a regimen for HIV patients. How can a specialty pharmacy mail a Prezista to a patient and not even question if he or she should be on anything else? Why is it that I have to explain to CVS Specialty that a patient on HIV drugs is on a regimen, and that regimen always includes multiple drugs.

It just pissed me off. At the end of the day, I did the refills, and I made sure the patient calls HR tomorrow to tell them to drop CVS Health as the pharmacy benefit for the company. We'll see how that goes.

It just pissed me off.

Don't even get me started on the insurance that prevented a patient from getting HIV drugs and put the patient in the hospital...

 

[BMBiology]

Have you sold your evil CVS stocks yet? LOL

 

[awval999]

You seem to be under the impression that the PBM and CVS specialty pharmacy cares about it's patients. The only reason that "specialty" pharmacies like that exist is save the PBM money. In fact in an ideal world (for the PBM) the HIV+ patient wouldn't even fill his medications because it is expensive for the PBM.

 

[NocturneGminor]

I don't know who remembers their HIV regimens or not, but after working in a pharmacy that dispenses 25% HIV medicatons, I pretty much recognize what's right and wrong, or what's unusual, or what's for a patient who is not receiving HIV drugs for the first time.

I just want to share an example of how so called "specialty" pharmacies are really not special at all. "Specialty" is just another term for preferred pharmacy in an insurance carrier's network. These pharmacies simply steer high cost, but the most profitable prescriptions to their own in house pharmacies. They are not doing anything special at all.

Today, a patient needed refills on HIV medications. Truvada, Intelence, Prezista, and Norvir. We run everything through to get a rejection of not appropriate at our location and must fill at specialty. I call CVS/Caremark to see if I can get my friends to fill it at their specialty pharmacy. Nope. There is only one specialty pharmacy in network and that pharmacy is CVS!

I don't want to get into details, so long story short, there was a lot of cursing and me forcing dumb as* supervisors at CVS Specialty and CVS Health PBM to get me a fu*king override to dispense the medications to my patient. The reason being:

CVS said they had the patients medications ready to be shipped, but my patient wasn't picking up the phone. I said I'll have the patient call you. The patient calls them and calls me back saying only one medication was ready. I call back CVS Specialty and say, "What do you have ready?" They tell me Prezista. I ask, "Where's the other HIV drugs?". They say they didn't have anything on file or any record of them.

SO WTF?! You are going to tell me you are going to dispense one HIV drug, an unboosted PI to a patient, without even knowing what regimen this patient is on? So then what is so special about a specialty pharmacy if they don't recognize that an HIV patient can't just get Prezista by itself, that there is a regimen for HIV patients. How can a specialty pharmacy mail a Prezista to a patient and not even question if he or she should be on anything else? Why is it that I have to explain to CVS Specialty that a patient on HIV drugs is on a regimen, and that regimen always includes multiple drugs.

It just pissed me off. At the end of the day, I did the refills, and I made sure the patient calls HR tomorrow to tell them to drop CVS Health as the pharmacy benefit for the company. We'll see how that goes.

It just pissed me off.

Don't even get me started on the insurance that prevented a patient from getting HIV drugs and put the patient in the hospital...

I hear you...also concerned for CVS/Walgreens/Safeway/Von getting into MTM, Chronic DZ Management, Infusion Pharmacy...they just think about money...that is it, so they will not do any of these properly just like what is happening to that HIV patient...it seems this whole world is driven by money-seeking evil...

 

[Dred Pirate]

What do you have ready?" They tell me Prezista. I ask, "Where's the other HIV drugs?". They say they didn't have anything on file or any record of them.

SO WTF?! You are going to tell me you are going to dispense one HIV drug, an unboosted PI to a patient, without even knowing what regimen this patient is on? So then what is so special about a specialty pharmacy if they don't recognize that an HIV patient can't just get Prezista by itself, that there is a regimen for HIV patients. How can a specialty pharmacy mail a Prezista to a patient and not even question if he or she should be on anything else? Why is it that I have to explain to CVS Specialty that a patient on HIV drugs is on a regimen, and that regimen always includes multiple drugs.

.

this is what concerns me the most - if you are going to call yourself a specialty pharmacy, you should at least know the basics of the specialty you claim to be part of. What extra service are they providing if they don't know basic HIV pharmacology?

 

[PharFromNormal]

I hear you...also concerned for CVS/Walgreens/Safeway/Von getting into MTM, Chronic DZ Management, Infusion Pharmacy...they just think about money...that is it, so they will not do any of these properly just like what is happening to that HIV patient...it seems this whole world is driven by money-seeking evil...

Greed is good.

 

[CynicalIntern]

I hear you...also concerned for CVS/Walgreens/Safeway/Von getting into MTM, Chronic DZ Management, Infusion Pharmacy...they just think about money...that is it, so they will not do any of these properly just like what is happening to that HIV patient...it seems this whole world is driven by money-seeking evil...

This is painting with a very broad brush. Yes, CVS Specialty, as an entity, is unilaterally terrible. Every office around me hates them, and everyone who works in a "specialty" setting is infuriated by them.

But saying "every Walgreens, CVS, etc shouldn't be doing any kind of clinical anything" is not only placing yourself on a supremely high pedestal, it's also a slap in the face to every pharmacist who works for these companies. Yes, these corporations by and large are overworked and understaffed. But that doesn't make their pharmacists incapable of properly doing specialty work.

In honesty, I've worked for four different specialty WAGs, and because the scripts are so profitable, you get a lot more budget support as well. And currently I am crushing my local independent in local market share, not because of contracts or money passing hands, but because I am better at it than them. I open up on the holidays for their emergencies, I drive scripts out myself to patients who have FedEx screw things up, offices call me on my cell if they have after hours emergencies, and I'm better at manipulating insurances than any of my competition.

That said, yes, CVS Specialty is terrible. You don't know frustration until they are actively OUT of a medication, and still refuse to let you fill it without a three hour argument for an override. Though it's easy to lose perspective, it's not the facility itself who does this (though they are terrible in their own way) - it's the PBM.

 

[farmadiazepine]

This is painting with a very broad brush. Yes, CVS Specialty, as an entity, is unilaterally terrible. Every office around me hates them, and everyone who works in a "specialty" setting is infuriated by them.

But saying "every Walgreens, CVS, etc shouldn't be doing any kind of clinical anything" is not only placing yourself on a supremely high pedestal, it's also a slap in the face to every pharmacist who works for these companies. Yes, these corporations by and large are overworked and understaffed. But that doesn't make their pharmacists incapable of properly doing specialty work.

In honesty, I've worked for four different specialty WAGs, and because the scripts are so profitable, you get a lot more budget support as well. And currently I am crushing my local independent in local market share, not because of contracts or money passing hands, but because I am better at it than them. I open up on the holidays for their emergencies, I drive scripts out myself to patients who have FedEx screw things up, offices call me on my cell if they have after hours emergencies, and I'm better at manipulating insurances than any of my competition.

That said, yes, CVS Specialty is terrible. You don't know frustration until they are actively OUT of a medication, and still refuse to let you fill it without a three hour argument for an override. Though it's easy to lose perspective, it's not the facility itself who does this (though they are terrible in their own way) - it's the PBM.

It took me all day.. starting from 11 in the morning until almost 5 in the evening, making calls back and forth and back and forth, and being told to call this number, and that number, then this number.. I got so f*cking fed up that I said "Get me a f*cking supervisor", and when the supervisor said I had to actually call another phone number I finally said "No, you must be f*cking kidding me, I been calling you all day long and you guys keep sending me back to the same people who say to call you".

I finally got them to override all the medications for my patient, Truvada, Intelence, Prezista, and Norvir, but it was only after fighting for hours that anything was done.

Now I have the patient writing a letter to CVS Health demanding to be taken out of mandatory CVS Specialty pharmacy for HIV medications.

And you're right, its not every CVS, Walgreens, etc, because that is a slap in the face to every pharmacist. I was a CVS pharmacist until 4 months ago, and I thought I did a damn good job at what I was doing, but my day time staff were complete *****s, 40 something year old heavy set women who didn't know anything about medication except what a KPM was and how to use MySchedule, and still the scheduling sucked.

 

[CynicalIntern]

Have them quote the ADA. That's been brought up in lawsuits against ESI and AETNA in the past year for mandating use through specialty pharmacy.

I'm actually starting to get people refuse to let me talk to supervisors, saying "there is not one available right now"

That's totally fine, but I'm going to stay here on the line until you get me one. The one thing that you are graded on is how fast you can get me off the line, and you can't hang up on me by policy. So I'll happily keep this phone call going in the background and torpedo your entire month's scores if you don't get me a supervisor!

 

[Jibby321]

Have you sold your evil CVS stocks yet? LOL

I haven't. Still have mine from 2010-2011. I think I bought them between 35-55 a share. Now over 100?!?!

 

[farmadiazepine]

Have them quote the ADA. That's been brought up in lawsuits against ESI and AETNA in the past year for mandating use through specialty pharmacy.

I'm actually starting to get people refuse to let me talk to supervisors, saying "there is not one available right now"

That's totally fine, but I'm going to stay here on the line until you get me one. The one thing that you are graded on is how fast you can get me off the line, and you can't hang up on me by policy. So I'll happily keep this phone call going in the background and torpedo your entire month's scores if you don't get me a supervisor!

I just took a look into what Consumer Watchdog did to United, BCBS, etc, and wow. This is exactly what needs to happen. I am going to share this with my owner and we'll see what we can do. The City of Paterson currently has prescription benefits through CitizensRx and they force all HIV patients to go to only CVS Specialty for HIV drugs. That can't happen. The issues of patient health, safety, and privacy, and the issues of discrimination are what I'm going to bring up. Thank you so much for the information!

http://www.consumerwatchdog.org/story/united-hivaids-patients-settle-mail-order-drug-dispute

http://www.consumerwatchdog.org/resources/bcbsdemandletter.pdf

http://www.consumerwatchdog.org/search/apachesolr_search/HIV/AIDS

http://www.healthlaw.org/publications/browse-all-publications/HHS-HIV-Complaint#.VPJRD_nF-Sq