By MATTHEW HOLT
At this time we’re going to have enjoyable with present and inform. I’m going to point out you ways a little bit nook of American well being care is making my life as a shopper worse and dearer–hopefully somebody can inform me why.
The forged members are: me, my MD, the (form of) unbiased pharmacy that delivers, Alto, and my insurer Blue Protect 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 keep 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 previous males like me. My ldl cholesterol has come down, however my MD advised me it might come down extra, so a couple of months in the past we boosted the dose to 40mg from 20mg.
Till not too long ago 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 concerning the enjoyable and video games available attempting to determine what their PBM (CVS Caremark) was doing with the pricing of my child’s ADHD medicine. However they’d by no means messed with my medicine as my statins are low cost. At the least I assumed they had been. In truth as not too long ago as April final 12 months, they had been free. You’ll be able to see the value from the supply from Alto Pharmacy beneath.
How BCBS Mass got here up with $0.00 as the value I pay I don’t know, however presumably they suppose it’s an excellent factor to have me on statins within the hope I don’t have an (costly) coronary heart assault as a substitute.
Then for some motive my value for the statin later the identical 12 months went as much as $23. Not $0 however at $8 a month not likely value 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 with a purpose to maintain entry to my household’s docs at One Medical, I selected the one plan they had been in, the Blue Protect of California HMO.
My subsequent 90 day provide was the primary one which went from 20mg to 40mg, but it surely’s nonetheless a typical generic. Blue Protect 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 associated fee 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.
Dangle on, why change a 90 day provide for a med I’m alleged to take day-after-day endlessly for a 30 day one?
I enquire to Alto’s message system and so they blamed Blue Protect.
And naturally Alto now could be solely allowed to fill my different meds on a 30 day cadence additionally.
So mainly it seems like Blue Protect’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 may be value what it prices for money. GoodRx’s most cost-effective charge is about $18 for a 90 day provide. However after all I’ve to drive to choose it up, whereas Alto delivers. I’ll pay $10 extra each 3 months for that.
Enjoyable with customer support: So now to serve the nice readers of THCB and since I’m bloody minded concerning the shopper expertise, I determine to seek out out from Blue Protect what is definitely occurring. (I additionally dwell 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 positive you’ve seen the South Park version by now)
The reply isn’t properly. BCBS Mass had a chat perform, if no AI. Blue Protect of California has a telephone line. With voice recognition that, properly, doesn’t work.
After they ask me my date of beginning and are satisfied my sixty is a fifty. It’s additionally obvious their voice recognition can’t perceive “NO” and but they’re so assured it’s good they received’t let me “Press 1 for sure or 2 for no”. However they’re glad to inform me that descriptions of advantages aren’t a assure of fee & I ought to schedule a wellness go to–despite the fact that they acknowledge my telephone quantity and so they’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 beginning 12 months.
Blue Protect the tech chief: In its public pronouncements Blue Protect is claiming that it’s updating its tech. In truth 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 equivalent letters to inform me that I had modified my PCP, which I had advised them within the first place!
You could 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 Protect 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 value for 90 days was $28, for 30 days $19. So if I saved it with Alto my annual value would go from round $112 to $228. So if I did nothing somebody could be maintaining the additional $116.
You could 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 had been to inform me that Blue Protect, “not us”, insists that I get this drug through mail order. So who’re “you” I ask? “CVS Caremark” they are saying. So “how do I get my Rx through CVS Caremark” I ask? You are able to do it on the Blue Protect website. And should you hunt round a bit you may.
So I gamely click on via on the Blue Protect website, by to the CVS Caremark sub-site for Blue Protect, register with my ID quantity on the CVS Caremark website 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 website, and naturally the 2 websites can’t talk…and so they invite me to name again.
However as a result of I’m a sucker for punishment I attempt once more, and see if I can determine another means within the Blue Protect website. There I discover a drug pricing software.
I wish to know the associated fee to me of shifting to the CVS Mail order. The software is aware of the medication I’m on! I ask it for the value 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 through 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 based mostly on the declare from February) to see what the pricing is through mail order.
And naturally you may guess what the response is.
The reply is that 90 days provide isn’t obtainable in a retailer and apparently neither is 90 days provide obtainable through mail order. And for this fabulous expertise they need to cease me utilizing Alto Pharmacy. Presumably they need me to power my physician’s workplace to resubmit the Rx to CVS mail order.
In case you are nonetheless maintaining rating, someplace between Blue Protect and CVS Caremark, for a upkeep drug that they need to encourage me to be on (I assume), which prices them virtually nothing to amass, they need me to alter pharmacy and/or hassle my physician.
We nonetheless received’t know if it really works, and for that matter it’s not sure who will get the additional $116 if I am going again to 30 days at Alto.
And naturally it might be simpler and cheaper for me to pay the $11 + delivery it might value me to buy 90 days supply at Mark Cuban’s Cost Plus drugs. However then it wouldn’t rely towards my deductible, and my insurer, who presumably is meant to care about my well being and my Rx adherence, received’t know what medication I’m on.
I hope you’ve loved this little journey by this obscure nook of the American well being care system. Bonus factors should you can clarify why anybody would need to undergo this, or what the hell Blue Protect or CVS Caremark are gaining for making me do it.
