By MATTHEW HOLT
Right this moment we’re going to have enjoyable with present and inform. I’m going to point out you the way just a little nook of American well being care is making my life as a client worse and costlier–hopefully somebody can inform me why.
The forged members are: me, my MD, the (form of) unbiased pharmacy that delivers, Alto, and my insurer Blue Defend of California and its PBM CVS Caremark, which additionally owns a mail order pharmacy.
The transient backstory: For some years my physician has been whining about my excessive ldl cholesterol, and some years again I went on a statin known as Rosuvastatin Calcium. Older readers might bear in mind Jean Luc Picard himself promoting the branded model Crestor, however it’s been off patent for a couple of decade. About 50 million Individuals now take a statin, virtually all of them a generic, together with many 60 12 months outdated males like me. My ldl cholesterol has come down, however my MD advised me it might come down extra, so a couple of months in the past we boosted the dose to 40mg from 20mg.
Till not too long ago I’d been insured by BCBS Massachusetts, and also you may recall just a little over a 12 months in the past I wrote a piece on THCB in regards to the enjoyable and video games available attempting to determine what their PBM (CVS Caremark) was doing with the pricing of my child’s ADHD treatment. However they’d by no means messed with my treatment as my statins are low cost. At the least I assumed they have been. The truth is as not too long ago as April final 12 months, they have been free. You’ll be able to see the value from the supply from Alto Pharmacy beneath.
How BCBS Mass got here up with $0.00 as the value I pay I don’t know, however presumably they assume it’s a very good factor to have me on statins within the hope I don’t have an (costly) coronary heart assault as an alternative.
Then for some cause my worth for the statin later the identical 12 months went as much as $23. Now not $0 however at $8 a month probably not price making a fuss about.
On the finish of the 12 months, COBRA expired and I went to purchase insurance coverage on the California trade. And with the intention to preserve entry to my household’s docs at One Medical, I selected the one plan they have been in, the Blue Defend of California HMO.
My subsequent 90 day provide was the primary one which went from 20mg to 40mg, however it’s nonetheless a standard generic. Blue Defend of California additionally makes use of CVS Caremark (though it’s been talking a good game of ditching CVS Caremark and setting up its own PBM) and the price at Alto barely budged. Now it was $28.
What occurred subsequent: So all was going usually till late final week when my subsequent 90 provide was delivered. Besides it wasn’t. Alto delivered me a 30 day provide and charged me $19.
Hold on, why change a 90 day provide for a med I’m alleged to take each day without end for a 30 day one?
I enquire to Alto’s message system they usually blamed Blue Defend.
And naturally Alto now could be solely allowed to fill my different meds on a 30 day cadence additionally.
So principally it seems to be like Blue Defend’s mail order service is taking part in hardball. They need me to maneuver my 90 day order to them.
A diversion: Earlier than I try this, it could be price taking a look at what it prices for money. GoodRx’s least expensive charge is about $18 for a 90 day provide. However in fact I’ve to drive to select it up, whereas Alto delivers. I’ll pay $10 extra each 3 months for that.
Enjoyable with customer support: So now to serve the great readers of THCB and since I’m bloody minded in regards to the client expertise, I resolve to search out out from Blue Defend what is definitely taking place. (I additionally dwell tweeted the enjoyable and video games)
“I’m on with @BlueShieldCA maintain music. Let’s see how they do compared with South Park….” (I’m positive you’ve seen the South Park version by now)
The reply will not be properly. BCBS Mass had a chat perform, if no AI. Blue Defend of California has a telephone line. With voice recognition that, properly, doesn’t work.
After they ask me my date of start and are satisfied my sixty is a fifty. It’s additionally obvious their voice recognition can not perceive “NO” and but they’re so assured it’s good they received’t let me “Press 1 for sure or 2 for no”. However they’re completely happy to inform me that descriptions of advantages aren’t a assure of cost & I ought to schedule a wellness go to–despite the fact that they acknowledge my telephone quantity they usually’ve already paid for a wellness go to this calendar 12 months. There’s over three minutes of irrelevant messaging, then 90 seconds of additional identification which doesn’t work as a result of it nonetheless can’t inform my start 12 months.
Blue Defend the tech chief: In its public pronouncements Blue Defend is claiming that it’s updating its tech. The truth is Exec VP Peter Lengthy has been boasting about it on Linkedin
The common tweet reader might recall them earlier this 12 months sending me 5 an identical letters to inform me that I had modified my PCP, which I had advised them within the first place!
Chances are you’ll surmise that I’m not seeing their tech upgrades as bettering my expertise…but.
So again to my statin. You’ll recall that it appears Blue Defend transformed a upkeep statin I had been receiving from Alto Pharmacy to 30 days with out telling me, and with out permitting Alto to fill it for 90 days. Presumably they need to transfer this to their PBM/pharmacy to maintain the revenue.
My value for 90 days was $28, for 30 days $19. So if I saved it with Alto my annual value would go from round $112 to $228. So if I did nothing somebody could be holding the additional $116.
Chances are you’ll recall that I used to be on maintain. An agent got here on the road finally and advised me I’ve to talk to the pharmacy. After being on the decision for 22 minutes, somebody got here on and their opening phrases have been to inform me that Blue Defend, “not us”, insists that I get this drug by way of mail order. So who’re “you” I ask? “CVS Caremark” they are saying. So “how do I get my Rx by way of CVS Caremark” I ask? You are able to do it on the Blue Defend website. And for those who hunt round a bit you possibly can.
So I gamely click on through on the Blue Defend website, via to the CVS Caremark sub-site for Blue Defend, register with my ID quantity on the CVS Caremark website and get this:
This has taken me 26 minutes on the decision, (not counting the primary 5 min name that dropped), 10 minutes screwing round on the @blueshield & @CVSHealth website, and naturally the 2 websites can’t talk…they usually invite me to name again.
However as a result of I’m a sucker for punishment I attempt once more, and see if I can determine another means within the Blue Defend website. There I discover a drug pricing device.
I want to know the price to me of transferring to the CVS Mail order. The device is aware of the medication I’m on! I ask it for the value of my statin and it tells me it’s $19 for 30 days provide–the each worth Alto charged me. It additionally tells me I can get 90 days by way of mail order!
So I click on on that hyperlink and now it sends me to @cvspharmacy (once more) , which lets me click on on a current Rx I’ve crammed (I assume based mostly on the declare from February) to see what the pricing is by way of mail order.
And naturally you possibly can guess what the response is.
The reply is that 90 days provide will not be accessible in a retailer and apparently neither is 90 days provide accessible by way of mail order. And for this fabulous expertise they need to cease me utilizing Alto Pharmacy. Presumably they need me to pressure my physician’s workplace to resubmit the Rx to CVS mail order.
If you’re nonetheless holding rating, someplace between Blue Defend and CVS Caremark, for a upkeep drug that they need to encourage me to be on (I assume), which prices them virtually nothing to amass, they need me to alter pharmacy and/or hassle my physician.
We nonetheless received’t know if it really works, and for that matter it’s uncertain who will get the additional $116 if I am going again to 30 days at Alto.
And naturally it might be simpler and cheaper for me to pay the $11 + delivery it might value me to buy 90 days supply at Mark Cuban’s Cost Plus drugs. However then it wouldn’t depend towards my deductible, and my insurer, who presumably is meant to care about my well being and my Rx adherence, received’t know what medication I’m on.
I hope you’ve loved this little journey via this obscure nook of the American well being care system. Bonus factors for those who can clarify why anybody would need to undergo this, or what the hell Blue Defend or CVS Caremark are gaining for making me do it.
