Express Scripts & other money stealing middlemen

The BBQ Pit
1

I pit Express Scripts, and all the other money stealing middle men PBMs (Pharmacy Benefit Managers).

Here

You want to know the problem with health care? It is all the freaking middle men skimming money out of the system! Express Scripts now controls over 60% of every prescription filled in the United States, and all they (and other PBMs) really do is skim money between the actual insurance companies who pay, and the companies who self insure, and the pharmacies that actually fill the prescriptions and do the work. Finally, there is an article showing how much they actually skim, one prescription, they bill $92 to the company, but only pay $26 to the pharmacy (which has to pay for the actual product, the lights, the vials, the paper, the pharmacists, the techs, the time to fix the doctors errors, to council the patients, and more). So the “middle men” who only job is to move money around, and make pharmacy transactions easier, received three times the money the people actually doing the work did.

A year ago, Walgreens, the largest retail pharmacy chain, refused to sign a contract with Express Scripts, they stated that the contract offered made Express Scripts over 10 times the profit they made on each prescription they filled. Express Scripts then bought the 2nd largest PBM (Medco), placing themselves into a great majority of scripts filled, and FORCING Walgreens and others to accept their dictated contracts.

Pharmacy Benefit Managers claim that their services help to reduce medication costs by negotiating with pharmacies and manufactures for better prices… Why then has the average cost of a medication increased over 10 times since PDMs first started in the 70’s? All they do is act as middle men and confuse pricing. No one knows what medication actually costs anymore!

Since this is the pit, let me just say, FUCK YOU Express Scripts! FUCK your lowly reimbursements! That $60 spread in billing and payment on ONE script would pay for an entire extra tech per a day! No wonder all the PBMs are demanding mandatory mail order, you don’t want anyone to know what awful payments you make, and want to keep all the money for yourselves…

All the PBMs are is middle men, standing between your doctor and pharmacist who prescribe and fill your prescriptions, and your insurance company who pays, and pharmacy who gets paid…

You want to lower healthcare costs? Express Scripts, who are middle men, made over $500,000,000 PROFIT last year (including acquisition of the 2nd largest PDM) while they are JUST middle men!

$65 on one prescription, on a generic antibiotic, and you wonder why health care costs are rising?!?!?

2

Fuck me.
Express Scripts; Ticketmaster of the pharmaceutical world.

3

Ticketmaster at least makes things convenient for consumers and guarantees authenticity for ticket resale and so on. I’ve yet to see evidence that Express Scripts provides a benefit to anyone.

4

Those PBMs are really big into mail order drugs, so presumably they’re their own pharmacy for those orders.

I think a lot of their business is really in maintenance drugs that people take every day/week/etc… not in the someone has a flare-up of eczema and their dr. prescribes them some steroid cream, or z-pak for sinus infection type prescriptions.

My guess as to why they’re so prevalent is that they must provide some value or cost savings for the insurance companies- lower drug costs or easier processing, single point of contact, or something along those lines. I seriously doubt that the end users of the drugs are very much in their business model.

5

For what it’s worth, I used to be with Medco and now am with Express Scripts, and the cost to me of my prescriptions did not change noticeably. All generic, all still between $10 and $20 for a 90-day supply. At one point, Medco forced us to go to mail order prescriptions instead of my local pharmacy. And I didn’t find it too objectionable since the mail-order versions were cheaper.

Not that I’m questioning your facts, but perhaps Medco was no better, just smaller. I don’t like to see any company take over that much of any market. It sounds like an anti-trust investigation might be in order. If the government were open, maybe someone would be looking at them.
Roddy

6

Couple of points -

" Meridian didn’t know what it cost the PBM to fill that order." is total BS. AWP (average wholesale price) of all drugs is an industry standard and is published, and public. Further, contracts between a PBM and client (Meridian in this case) has all the details of charges, costs, and includes guarantees for savings, etc. If the guy in the article is in charge of rx costs for Meridians employees, he was likely involved in developing and signing that contract.

There is an entire department inside of PBMs dedicated to client audits. A client can audit everything, ask for and get details to make sure they are not overcharged, etc.

If ESI is causing Meridian’s RX cost to rise,they signed a really bad contract.

Next, its tough to even trust the numbers - there are so many variables between pharmacies, number of pills, in house hospital pharmacies vs retail pharmacies, in/out of network pharmacies, etc. that without more info, just pulling those 2 amounts is not enough info.

  • $500M profit is actually on billions in sales. Profit margins are very very thin at PBMs - often only 2-3% (compare that to Apple, or Exxon).
7

Medco was actually much bigger than ESI - ESI became the buyer due to financial reasons.

Also, the merger/acquisition spent many months being reviewed by all sorts of government agencies, including Congressional hearings, etc. so its pretty much been investigated already.

8

Excuse the potential zombie…

I am trying to renew a prescription for the first time since Medco was swallowed by Express Scripts. Ugh. They’ve lost ALL SIX of my doctor’s faxes with my new prescription, despite at one point actually send me a shipping date estimate (for a prescription they never received? huh?). The last straw was when they emailed me to let me know they’d sent me a letter explaining why they can’t fill my prescription (that they now claim to have never received). The letter just told me to call an 800 # for more info. So I did, only they only have customer service on weekdays, so I waited 'til Monday. The customer service rep read me a note on my file that was full of impenetrable jargon and codes which she was unable to explain to me.

So I called my insurance company and it turns out this drug will be covered 100% at a local pharmacy for a 30-day supply. I’ll be switching to the independently owned pharmacy at the end of the block, thank you very much. I did my part for 4 years and filled it as a 90-day supply through Medco, ostensibly saving the company money. No more.

9

I used to use Medco… had no idea they went out of business … well none of this stuff is surprising anymore, it’s all a big mess.

I got sticker shock the other day when I had to pay full amount for a prescribed medicine for my mouth. One hundred dollars for 45 lozenges . I did of course… my darn mouth hurt.

10

I am interested in pursuing this business model; properly refined, not only could one buy x from a company, and then sell it back to them for a turn-around profit, but ideally no interaction with goods would be necessary, since they could remain in situ with the company at all times, obviating their security and delivery concerns.

11

(Bolding mine) Former ESI/Medco/Liberty supervisor speaking!!!, you spoke to an idiot. There are a LOT of idiots working for ESI currently. My call center dealt with Medicare patients. The “note” on the file, while it IS usually a form letter, it almost ALWAYS has to do with coverage for the medication on your plan. The correct move would have been to double check coverage notes for your med meaning to see if your plan covers it (through mail or retail), if it requires a prior authorization from your doctor, and, if it is not covered, what options are available for you. Coverage rules can be tricky and it sounds like your plan covers specific meds at retail only for $0 copay (but not mail). Either way, the CSR should have known.
FYI, I was the “supervisor” that everyone who was pissed off wanted to talk to. I did that for over 3 years and I was VERY good at it. I decided I needed to move on though because it is a soul sucking position. I’m currently enrolled in college. :smiley:

12

I had a rant a while back about the rack rate for drugs at places like CVS versus the price of the same drug when reimbursed by insurance or when purchased from places like Costco or Walmart.

$100 CVS drug costs something like $20 at Costco. There is really no excuse for this sort of price disparity in a free market economy. Something is seriously broken with drug pricing.

13

I have my prescriptions through Express Scripts and try like hell to never use them. Walmart’s $4 formulary has been a lifesaver. And fuck your mandatory mail service. I don’t **want **to wait for you assholes to mail me my drugs, and risk them being diverted out of my mailbox. I like going to pick them up myself.

NOBODY likes Express Scripts except insurance companies.

14

Lol. The mail service was never mandatory, but the plan design heavily favors its use with lower copays. Only government employees had exceptions (and new York residents, due to some law).

15

My very large company used to use Medco - when Express Scripts took over they dumped their ass asap. Before they did though they were calling or emailing me every five minutes to get me to renew right now - though I had a 3 month supply of everything. It was no doubt to get the business before they got dumped. So Express Scripts in my brief experience was much worse than others I used.

I like on-line prescriptions because it is cheaper and easier - but I get my thyroid pills at the local non-chain pharmacy, since I want there here in emergencies and want to keep them in business. But I am torn.

16

Good guess, but it’s actually covered at 100% either way - 90-day supply through Express Scripts or (as I now know) 30-day through retail. Or so says the rep from Blue Cross Blue Shield. And she should know. :slight_smile: And the local pharmacy filled the prescription within an hour of my doctor sending it over. We never had this problem with Medco, and our policy has not changed since the takeover. The only thing that has changed is the name of the mail order pharmacy.

17

I was right, you spoke to an idiot. :smiley:

I worked with Medco prior to getting absorbed into ESI so I feel you pain. Well actually not since I resigned but you get the idea.

18

What do you know? Mail-order service absolutely was mandatory on my insurance plan for any “maintenance medication” that I needed for more than three months in a row. They would not cover prescriptions that I filled in-person at a pharmacy for more than 3 consecutive months. I called to confirm this and was told that they would not pay a cent for such a drug after 3 months if I did not use their in-house mail-order pharmacy. Online verbage confirmed the same policy (maybe that was my employer providing shitty coverage, but it happened).

The only alternative to mail-order was paying $80 a month (starting on the 4th month) for birth control. Or getting my gynecologist to change my birth control prescription to something on Walmart’s no-insurance formulary.

19

Bolding mine. What do I know? It was my job, I know everything about how ESI works with respect to formulary rules and coverage. . This is something they call a retail refill allowance. The plan still “covers” it, but does not contribute toward the cost of the medication. If you decided to still purchase it, the money paid would still appear on your benefits statement, the dollar amount would contribute to any yearly accruals (like deductible, coverage gaps, etc…) unless you instructed the pharmacy to run it outside your plan.

It’s semantics and it’s crap like this that I had to argue with customers all the time when I worked there. I totally agree with you that it is stupid.

20

You assface. Nobody who doesn’t work at a retarded middleman would see the difference without this explanation. If my plan doesn’t pay for my medication, then the benefits for all PRACTICAL purposes don’t exist. You were being willfully obtuse earlier, now get the fuck out of here.