PBM Watch: A smooth transition to a better PBM? One STRS retiree's chronological tale!

Jan. 30, 2008

I received another "canned" phone call from ES at 15 to 4 this afternoon. They informed me that they had received an order from someone at this household and that they are in process of filling it.............Now, this was just one day after they told me they had the order in the mail!..........I am assuming they are responding to both of the refill requests that were made. One was made in early Jan. and when I didn't hear from them a week later I phoned and a live person said that the order was filed but apparently "thrown out" by the computer so she reordered the refill. (Think I told you all this.)..........Anyway, I am hoping that at least one of the refills is in the mail...........

January 30, 2008 (After reading Duane Tron’s story)

WOW! For your info----I did finally get a call from ES about 5 p.m.on the 29th saying they were shipping my refill (originally ordered Jan. 17th). I'm still waiting for it to arrive. Once I have it in hand, I could write up the details if you still want it...............I BETTER get those 4 refills called in immediately. Afraid I'm going to be caught as Duane is.............

Jan. 31, 2008

I decided I could not wait any longer for my first-ordered refill to arrive before requesting the 4 other refills I need.........At ES's rate of response that I am experiencing I will be out of all my meds!

So I called the automatic reordering. Managed to get 3 refill requests completed but kept getting the response " Incorrect prescription number" on the 4th one. It just so happens that No. 4 is the same medication as what I had originally ordered in early Jan. just a different strength/dosage. So I thought the confusion was probably due to it being the same drug.

So I phoned and spoke to a Consultant. She took time to read all that was in my case notes and got back to me with this bit of news.......When I ordered the first refill, ES decided to send both doses (which I have not yet received.). They sent one dose as the Brand med, which is what I wanted and was written by the doc as such. BUT they sent the second as a Generic! I told her that the remaining pills I have left from, Caremark were Brand and that I did not take Generics.

She said that ES automatically sends Generics unless the doctor specifically marks each script as Brand only. (I don't know if my doc did or not on that particular script.) I was taken back that they automatically send generics. She said that she could mark my file as ONLY Brand names, no generics. I okayed that. So, if I want a generic, my doc has to say so on the scripts that are written in the future.............I am going to have to be extremely vigilant in the future every time I order.

I asked if I could go to my local pharmacy and get a Brand name of the drug since ES was not going to send it to me. She said, Yes, but I still would have to present my ES card for the local pharmacy to get ES's ok. (That is what infuriates me!) I would probably have to go to a strange town and a small pharmacy and not show my ES card to get a drug on my own! And then I wonder.............

Now, here is the final blow...........Since both of the doses have been shipped and billed to me, I am going to have to pay for them both..........The Brand name that I will use and the Generic that I won't use. The cost is minimal but it's the principle.....RIGHT?

About two hours later I got an automated message from ES telling me my recent order has been shipped and a tracking number was given to me. ....... Can I believe them??? Especially since I am still waiting for that first order that was placed in early January!

Good luck in understanding all of this. I'm sure glad I kept notes because it is so confusing!

Jan. 31, 2008

I am well aware of the need for the DAW (dispense as written) . If a doctor writes a prescription with the Brand name why should they have to put DAW on it anyway? Caremark at least made an attempt to notify you or double checked before sending you a Generic but Express-Scripts just blatantly makes them all generic without your permission regardless what drug name the doctor wrote. And they are doing it with refills, too. That is SH--! And in my case dangerous................Now I am venting................

Jan. 31, 2008

Oh, yes, please let Shirlee know of my Medicare problem if you decide it is appropriate. Here is the situation..........One of the tests that my functional medicine doc. ordered was through a lab in North Carolina. Through multiple miscommunications the lab bill was never processed through Medicare. That was supposed to have been done by the Lab (according to my doc.) because my doctor’s office does not bill that. However, I paid the whole bill which was approx $375. This was back in Nov. I just recently learned that it should have been sent to Medicare by the Lab. When they were notified, the Lab (for some reason) refused to rebill Medicare.........Now, what can I do to get this bill to Medicare. It seems that I need to take charge at this point. Who do I call at Medicare? Is there a form that I need to fill out. I don't know where to begin or even if Medicare will consider reimbursement to me

Jan. 31, 2008

I went to CVS to pick up the 15 pills and Express Scripts refused to allow them to bill it against my prescription insurance as they told CVS that my med prescription had been processed and was being shipped................

This happened to me when we were with Caremark. I do believe it is a standard procedure with these mail order pharmacies. It is a safeguard for the individual and for the company. It prevents us from getting drugs beyond the prescribed amount and it saves them money which is a part of saving us money. I don't like this any better than anyone else but that is how things run when we don't have personal control. And we don't because we can't afford it in the world of today.............Can you imagine the mess when our government takes over!!!!?

I believe we should blast Express Scripts for poor service that they can control but we have to realize that procedures will be adhered to for whatever reasons. I'm sure it is "in the plan".

I feel sorry for those caught in the trap but I'm happy they/we have a place to VENT!

February 1, 2008

Today I received one bottle of pills from ES. Unfortunately it is the generic and not the one I had originally reordered but the one they decided to send on their own. In the package was a form letter saying my doctor had okayed the substitution of the generic. I believe that to be a lie because she would not have done that. Quite possibly they may have talked to someone else in her office but I doubt that, too. Anyway, I asked why I only got one bottle and not the other dosage of the Brand because that is the one I ordered. I was told that this one was sent on 1/28 and that the Brand was mailed 1/30. I was assured that it is,indeed, the Brand medication.............I hope so because I will need it very soon!

I called my doctor's office and left a message asking if she wants me to take the Generic and what a mess ES has created for me. Her Girl Friday called back and said the doctor wants me on the Brand and they will send me the prescription marked DAW as requested............I wanted to have it in hand so I can call ES again and find out if they are going to balk at filling it for me because they had already sent me the Generic of the same dosage. If they do, I will find a local pharmacy to fill it without their knowledge.............however that maybe accomplished!!!!!

It absolutely amazes me that I still haven't received the refill that I originally ordered early in January!!!!!!