Actually, I do. I get a months supply of Enbrel through the mail(overnight FedEx) once a month. Delivered to my workplace with an adult sig required. Never had a problem. Originally I picked it up at local Walgreens, but had to switch. I’d love to give the local Walgreen’s the biz,but I understand why I have to do this.
Nah. I hate ESI too so I’ll stick around. Besides, in case you didn’t notice we are on the same side. I just pointed out how they would justify it in the terms of service. Just don’t get all butt hurt because you don’t know the details of your own plan.
The most common complaints about ESI/Medco or any other PBM is usually actually the result of plan designs chosen by your employer or insurance company.
Things like mandatory mail - they are put in place to not only make ESI money, but to save the client (employer, union, insurance company) money, and often also the patient. So, ESI is not really the one forcing you to go to mail, your employer chosen plan is.
If you have a problem with the formulary, pricing, mail vs retail - first complaint should be with your HR department, etc. not ESI. Though keep in mind, an employer is welcome to choose plans with every drug in the world covered, no mail incentives, etc - but it will cost a fortune!
Finally, the complaints about these types of companies being thieving “Middle men” - do you think it would be cheaper for you if your employer negotiated pricing contracts with every drug manufacturer (brand and generic) and retail pharmacy in the country themselves??
Don’t get me wrong - there are plenty of problems with ESI and other type companies and single payer would be a really easy solution with no middlemen, but in our current state of healthcare in this country, companies like ESI serve a valuable purpose.
Exactly correct.
And a bargain at that, maybe (though what WERE the lozenges? I’ve occasionally used an oral anti-fungal and it was nowhere near that much). I’m on a couple of meds that would be 300 or more per month if I were paying it all out of pocket; some of those are essential, some I could do without if I didn’t mind stumbling into walls, losing my job, etc.
No recent experience with ExpressScripts, except that my husband’s insurance plan was using Medco when it became ExpressScripts, and shortly afterward, IN THE MIDDLE OF A PLAN YEAR, switched to a different benefit manager.
But these plans do an amazing job of obfuscating who makes what decisions - I vented recently about the insanity with a forced prescription change that had some pretty damned bad (and odd - as in full-on zebra-ish) side effects. The prescription people said I had to talk to my company’s benefits people, my company’s benefits people said I had to talk to the prescription people, and the end result was basically that NOBODY would give me ANY explanation whatsoever for what a change was made (and reversed, without notice, 9 months later).
My other vent with this kind of schema is that many of the plans which use them require you to use their services after a couple months. Say you’re put on a new medication: you can get 3 fills locally, then go mail-order or they pay NOTHING.
When we were switched to a plan 2 years ago that was handled by Caremark, at least they set up a facility where I could get my 3-month supply locally if I wanted (at a CVS store). It’s very rarely been necessary, but last year when I ran out of my maintenance asthma med (my own fault) it was darned handy… and last month when the post office LOST a refill (it arrived 3 days before I ran out).
I really think such plans should be required to have a facility like that. It doesn’t even have to be with every drugstore chain - I’m willing to go to a specific shop. It’s just really nice to have a backup plan.
Other capriciousness on pricing and coverage is fun too. I take a medication to help me stay awake. I was on the newer, shinier version of it initially but the older version went generic and so I switched (huge cost savings for me). Because of the way the plan is set up, the insurer pays about 1200 for a 3 month supply of the generic of the older one, and I pay about 25 dollars.
BUT THE NEW VERSION WOULD BE CHEAPER!!! The total for the newer one (their share and mine) is 1,215. The total for the generic of the older one: 1,268. And with the rules re generic versus brand, they’d pay 200 less for the newer drug (and yes, I’d pay nearly 200 more). It’s wacko.
The same generic medication is not covered at all under my husband’s plan (relevant because I’m switching next year). 1,400 a month, all out of my pocket. BUT, the newer, shinier one is (at a lower cost to me but much higher cost to the company). Why the generic is so much more, I don’t know - I guess because some weird-ass decision was made to not cover it, so they didn’t bother to negotate a different rate?
When I worked there we were capable of waiving medication costs at retail as a backup plan. This “local supply override” was typically used when something was our fault,like our mail shipment was lost. The csr’s will only give you 7 days , which is worthless. However, you can effectively get however much we see fit for free . I waived retail copays on a lady’s expensive inhailer for 7 months straight due to some issue with her plan that wasn’t her fault. There is almost always a backup, just make sure you talk to the right person.
Yep, because its cheaper for you, cheaper for your employer and more profitable for ESI/Medco/Caremark.
You see, CVS/Caremark has a bit of a internal built in conflict of interest - which is a main reason both ESI and Medco passed on buying CVS when Caremark did. Most Pharmacy Benefit Managers are able to save thier clients and patients money, while making more for themselves by pushing them to get mail order Rx’s vs a retail pharmacy. However, CVS needs people coming in the store, walking past all the other products to the back of the store, asked to wait around a bit in the store, and walk by all the other products again on the way out in order to make money. They aren’t letting you get your Rx at the CVS store cause they are nicer, its cause they think they will still make as much or more money on you when you buy shampoo, aspirin, makeup and snickers bar while you are in there.