So, we recently changed insurance, and with it, we also changed the company that pays for and mails out drugs. So instead of Caremark, i once again have to deal with Express Script. I had hoped that in the 8 years I’ve been away they might have improved. Nope.
I need to take a PPI twice a day. Used to be Omeprazole. Now it’s Esomeprazole. I might be able to go back to Omeprazole, but that’s irrelevant, because the company treats them both the same. And i need to take it twice a day. I tried moving to once a day, on the advice of my PCP, and that didn’t go well. My gastroenterologist has convinced the PCP that the downside of taking it less often is worse than the downside of taking it twice a day.
So my pcp sent my prescription to Express scripts. He asked for 180 tablets, renewable 3 times, for a year’s supply. They sent me 90 pills, with 7 renewals. (And a large enough bill that i wonder if i couldn’t do better without them.)
So today they called me. After the computer confirmed it was me, and asked if i wanted to sign up for automatic renewals, they connected me to a human being. The human being asked my name and date of birth and also, “What are you calling about today?” You guys called me. Okay, so i confirm who i am and tell him why they said they were calling me. He said he’d transfer me to someone who could help me.
That person ALSO asked my name and date of birth and why i was calling. He also asked if i wanted my famitidine automatically renewed. Um, no, my doctor wrote a prescription for lots of that, but i only take it when the Esomeprazole isn’t enough (which is mostly only if o miss a dose) and y’all charge enough that I’m not going to buy every refill. But how about that Esomeprazole? “That’s not eligible for automatic renewal.” Why not? Can we fix that? “You need to have a prescription for more than a 56 day supply to be eligible.” But if you look, i actually have a prescription for a year, so can we maybe fix that, and give me a 90 day supply? "
After some discussion, he puts me on hold to talk to his technician, who can answer me.
A long time on hold.
I finally talk to the technician. “Your insurance will only pay for 90 pills”. He blamed my husband’s employer. We all know that the employer didn’t pick and choose which ordinary cheap medications it would but for how long, Express Script did. I guess, not the department that mails pills, but the department that negotiates drug prices, etc. But it’s still Express Script, just they had this rule 8 years ago. (Which magically went away when my prior employer switched from Express Script to Caremark, despite nothing changing in the employee-facing language about our insurance benefit.)
So eventually i learn that just like last time, if the doctor jumps through enough hoops he can get them to send me 180 pills. Yes, he’ll have to jump through those hoops every year.
Last time i had to deal with this, those hoops were onerous enough that sometimes the doctor failed, and had to try two or three times to get it to “stick”. Every year. Once, it took so long to get my damn drugs approved that my boss bought some for me when he visited family in India, where you can buy it for about the same cost as the “after insurance” cost in the US. Because otherwise i would have had to buy extremely expensive stuff in small quantities at a drug store.
I guess I’m lucky that you CAN buy the stuff without a prescription. And you CAN import it from India.
And the larger problem is our shitty health insurance system, and the fact that Pharmacy Benefit Managers have gotten a strangle hold on the drug distribution system. But if you have to deal with a PBM, you are better off with one that isn’t Express Script.
Express Script is just horrible.