I pit Express Script

The BBQ Pit
1

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.

2

Do you have to use Express Script? Amazon has some kind of prescription service. Maybe they’re better.

Sorry you’re going through all of that bullshit.

3

Here I thought there was a new, offensive poster named Express Script.
sorry

4

That’s the pharm insurer. But i dunno for sure.

5

By all accounts, working for them was also a nightmare going back as far as the 1990s.

6

I don’t want to be “that poster” - you know, the one who obnoxiously requests definitions of obvious acronyms. In this case, it doesn’t even matter what precisely a PPI is; the context makes it clear that it is a medicine you need, and that’s all we need to know.

But as a policy geek type who thinks of “producer price index” first, I’ll add a link that gives a medical definition of PPI, namely, “Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.”

Sorry. My inquiring mind wanted to know. And you have all my sympathy on the nightmare you described.

7

Thank you for this! I was mightily confused as well.

Seriously, how hard is it to adopt the publishing protocol of NOT using an abbreviation until the SECOND time the word/phrase is used?

I used to always ask. Now, I just move on. You either want to be understood by everyone, or you can’t be arsed.

Props to everyone who takes the time to make someone else’s writing more clear for the reader. You are very much appreciated!

8

Just to pick at nits, I gave the name of the drug in the very next sentence.

But yeah, what you say is correct, it’s a class of drugs that reduces stomach acid.

9

It’s rare that I actually have some knowledge of the topic being discussed on the Dope, but in this case I do. I work for a company that administers pharmacy benefits. We partner with the PBMs on behalf of our clients, but we aren’t a PBM.

Standard disclaimers: I’m not a doctor or pharmacist, I’m definitely not YOUR doctor or pharmacist, and take all this with a grain of salt (along with your regular medication).

I did some checking on Omeprazole and Esomeprazole. While we don’t include them on our list of Low Clinical Value medications (high-cost drugs that offer clinical benefits which can be achieved by lower-cost or over-the-counter medications), there are options available without a prescription. For Esomeprazole, you can use Nexium as an alternative, or even a generic version of Esomeprazole (available at CVS, Amazon, and likely any decent drugstore). You’d want to ensure you’re matching the dosage on your prescription with the dosage in the over-the-counter med, but otherwise they’re the same.

I’m in sorta the same boat as you with a maintenance medication. We switched our PBM from OptumRx to CVS this year, and the quantity limit on my cholesterol medication went from 180 pills to 30. The 180-pill prescription from my doc is still honored; I just have to go to the pharmacy six times over the course of a half-year, as opposed to one. It’s not a major hassle, but it does illustrate how the different PBMs adjudicate claims.

10

I was worried it might be another javascript framework

(Software developer problems)

11

Esomeprazole is the generic name of the branded drug nexium. I’m already asking for a generic drug. It’s also pretty cheap and has no potential for abuse. (I mean, i guess you could abuse anything. Maybe shove the capsules up your nose or something. But it’s not a drug anyone takes for fun.) It’s not especially dangerous. There are some risks if you take it forever (which i probably need to do) but not really any risk of accidental overdose or kids getting hurt or… So i have no idea why they want to limit it. I think they just have bad processes, and are a bad company to have to do business with.

Yes, that’s actually an improvement from my experience 8 years ago. They sent me 90 pills, and seem willing to send more every 45 days. Last time they just refused outright to fill it without a huge song and dance. But that makes the drug ineligible for automatic renewal.

And I’m disorganized, and that significantly increases the rush that i run out. And bad things happen if i run out. But partly, THEY CALLED ME TO INVITE ME TO AUTO-RENEW and then said they can’t auto-renew the drug i actually need. And they reminded me of when i ran out before because they were so hard for my doctor to deal with. So I’m pissed at them.

Someone who didn’t want to post publicly suggested i check out Mark Cuban’s pharmacy,

And it looks like using that without insurance will be cheaper than Express Script with insurance. And no less convenient. So I’m setting up an account there, and step 2 will be asking my doctor to send the prescription to them. I’m hopeful this will resolve both my pharmaceutical issue and my anger management issue. :wink:

12

Gotcha. I thought maybe your price through Express Scripts was higher than the over-the-counter (OTC) option. The Mark Cuban Cost Plus Drug Company approach is probably your cheapest path, but it does still require a prescription. Just wanted to make sure you were aware you could get this stuff OTC if needed – you don’t have to go through your doc to get it. And there are some pretty cheap OTC generic options available.

Express Scripts, CVS Caremark, and OptumRx (aka “The Big Three”) do some things very well, but they stink at many others – customer service being one of those “many others.”

13

I think I’m the dissenting opinion here, but for what I take (a bp med and omeprazole), Express Scripts is great.

My doctor prescribes 90 days at a time with or without refills, and I go to their site when I start getting low, and order more. They’ll contact my doctor, get the new prescription if there are no refills, and mail it to me. Very little fuss, very little trouble, and a bit cheaper than OTC omeprazole as well.

If I had to take a stab at the issue with the 180 pill prescription that @puzzlegal is experiencing, I’d bet it’s probably because they have some sort of system where they pre-stock 90 day bottles of common drugs like omeprazole/esomeprazole, and 180 throws all that off and requires some kind of manual intervention, which equals $$$, and they don’t like that.

14

Well, the issue might not be with Express Scripts; it could be with puzzlegal’s employer.

Depending on her company’s arrangement with Express Scripts, they could have their own quantity limits in place. Benefits brokers work with their clients (the employers / plan sponsors) to set up their pharmacy benefit plan, and frankly many brokers (and a lot of plan sponsors) don’t really understand the intricacies inherent in pharmacy. They focus strictly on the bottom line, as opposed to minimizing disruption and providing employees with the best clinical outcome at the best price.

15

I had some issues with CVS Caremark, but nothing that would prompt a pit thread. I think they are a lot more competent than Express Scripts. They also charged me a lot less for the same drugs. That might be because a different employer had a different contract, though.

@bump, when I got 180, it did usually come in two bottles. But is it really that much harder to toss two bottles in the mailer than one? They sometimes sent another drug at the same time – they obviously had capacity to toss two different bottles in the mailer.

Another suggestion I’ve heard is that they are afraid people will buy more than they need with insurance, and re-sell the extra. But this drug isn’t really expensive enough for the hassle of going through a friend to be worth it for most people.

Yeah, but unless I buy it from no-name selling via Amazon, it comes in much smaller quantities and costs a lot more than if I have a prescription. (checks Amazon – hmm, cheaper than Express Scripts but more expensive than Mark Cuban) All in all, I would prefer to buy from a provider I’ve heard of, that probably cares about its reputation.

That is a good option to have in an emergency. But it’s just galling to have have a prescription for a drug, a common, cheap, effective drug, and have to run out and buy it OTC at CVS because my doctor hasn’t dotted exactly the right I’s with the PBM.

At least I’m in better shape than my friend with diabetes. He had to make emergency uninsured purchases of insulin because his doctor was wrestling with his PBM. And I think that happened to him twice.

16

That’s actually what Express Scripts told me. I didn’t realize there were also brokers involved in negotiating those details. That seems absurd. What plan sponsor is an expert on what drugs its employees might need? I still blame the PBM for even having the option.

And since they seem to be willing to fill the 90-pill script 8 times a year, I don’t even see how they save money. They pay more in postage, and the only real “savings” are people who neglect to fill the prescription because they forgot, which (if my experience trying to wean down to once daily is any evidence) costs the employer more, as it leads to expensive follow-ups with gastroenterolgists that are covered under the “healthcare” side of the coverage.

17

Express Scripts won’t do omeprazole on an automatic refill basis. Insurance companies don’t consider GERD to be a disease, for some reason. The problem now with ES is that even automatic refills aren’t really automatic, as they want you to approve them shipping the auto refill, which makes it - you know - no longer automatic. I think it’s because they got their hands slapped for sending people too many pills for the sake of increasing profits.

18

Could be. They wanted to sign me up for auto refills if the famitidine. (Also a drug for acid reflux, but it’s my “rescue” drug, not my maintenance drug, so I said, “no”.)

19

Two ways actually. They apparently won’t save any money on you - but I recently stopped taking a prescription I had been taking for years. I had just filled a 90 day prescription so if I had a 30 day prescription, the insurance company wouldn’t have paid for the other 60 days worth that I was going to throw out. Same thing regarding people who go off the insurance.

It might not even be that Express Scripts is offering an option , exactly. I get my insurance through my former employer * as part of a large group which is self -insured - they pay various companies to administer the different pieces but ultimately, that group makes certain decisions about coverage as they are not actually buying insurance and that’s why I have to log in to websites as belonging to that particular group to get any information. I can’t just look up whether a doctor participates with United Healthcare or whether Caremark covers a particular prescription. Now, if that group decides they only want to fill 90 pills at a time, and Express Scripts won’t do that , I’m sure they can get Caremark or another PBM to do it. Which means they will all be willing to do it.

* This plan is offered to all state govt employees and many local govt employees in my state.

20

Sure, but i just don’t see any husband’s employer having strongly-held opinions about specific drugs. And this is a boring cheap generic drug, not something sexy that’s been in the news, or something that’s really expensive. Someone gave them a menu of options, and they, without knowing much about it, selected from that menu. Whether the menu was developed by Express Script or by some broker i can’t say. But i can say that i had exactly this problem with Express Script 8 years ago, and when my employer switched from Express Script to Caremark, the problem went away. (Caremark asked my doctor to confirm that the dose was what he intended, once. Then filled it every year after that.) Some I’m pretty sure this is an express script thing, even if technically they offer choices to the employer.