By MATTHEW HOLT
At this time we’re going to have enjoyable with present and inform. I’m going to indicate you the way a bit nook of American well being care is making my life as a shopper worse and dearer–hopefully somebody can inform me why.
The solid members are: me, my MD, the (kind of) impartial 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 referred to as Rosuvastatin Calcium. Older readers might bear in mind Jean Luc Picard himself promoting the branded model Crestor, nevertheless 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 About 50 million Individuals now take a statin, virtually all of them a generic, together with many 60 12 months outdated males like me.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 informed me it might come down extra, so a number of months in the past we boosted the dose to 40mg from 20mg.
Till just lately I’d been insured by BCBS Massachusetts, and also you may recall a bit over a 12 months in the past I wrote a piece on THCB concerning the enjoyable and video games available making an attempt to determine what their PBM (CVS Caremark) was doing with the pricing of my child’s ADHD remedy. However they’d by no means messed with my remedy as my statins are low cost. No less than I believed they had been. The truth is as just lately as April final 12 months, they had been free. You’ll be able to see the worth from the supply from Alto Pharmacy beneath.
How BCBS Mass got here up with $0.00 as the worth I pay I don’t know, however presumably they suppose it’s a great factor to have me on statins within the hope I don’t have an (costly) coronary heart assault as a substitute.
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 not likely price making a fuss about.
On the finish of the 12 months, COBRA expired and I went to purchase insurance coverage on the California change. And with the intention to maintain entry to my household’s medical doctors at One Medical, I selected the one plan they had been in, the Blue Defend of California HMO.
My subsequent 90 day provide was the primary one which went from 20mg to 40mg, nevertheless it’s nonetheless a typical 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 associated fee 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.
Cling on, why change a 90 day provide for a med I’m speculated to take every single day without end for a 30 day one?
I enquire to Alto’s message system and so they blamed Blue Defend.
And naturally Alto now could be solely allowed to fill my different meds on a 30 day cadence additionally.
So mainly it seems to be like Blue Defend’s mail order service is enjoying hardball. They need me to maneuver my 90 day order to them.
A diversion: Earlier than I try this, it is perhaps price what it prices for money. GoodRx’s least expensive price is about $18 for a 90 day provide. However after all I’ve to drive to choose it up, whereas Alto delivers. I’ll pay $10 extra each 3 months for that.
Enjoyable with customer support: So now to serve the nice readers of THCB and since I’m bloody minded concerning the shopper expertise, I resolve to seek out out from Blue Defend what is definitely occurring. (I additionally reside 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 certain you’ve seen the South Park version by now)
The reply shouldn’t be nicely. BCBS Mass had a chat perform, if no AI. Blue Defend of California has a telephone line. With voice recognition that, nicely, doesn’t work.
After they ask me my date of beginning 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 gained’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 fee & I ought to schedule a wellness go to–regardless that they acknowledge my telephone quantity and so they’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 beginning 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 equivalent letters to inform me that I had modified my PCP, which I had informed them within the first place!
You might surmise that I’m not seeing their tech upgrades as enhancing 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 wish to transfer this to their PBM/pharmacy to maintain the revenue.
My price for 90 days was $28, for 30 days $19. So if I stored it with Alto my annual price would go from round $112 to $228. So if I did nothing somebody could be preserving the additional $116.
You might recall that I used to be on maintain. An agent got here on the road finally and informed me I’ve to talk to the pharmacy. After being on the decision for 22 minutes, somebody got here on and their opening phrases had been to inform me that Blue Defend, “not us”, insists that I get this drug through mail order. So who’re “you” I ask? “CVS Caremark” they are saying. So “how do I get my Rx through CVS Caremark” I ask? You are able to do it on the Blue Defend web site. And for those who hunt round a bit you may.
So I gamely click on via on the Blue Defend web site, by means of to the CVS Caremark sub-site for Blue Defend, register with my ID quantity on the CVS Caremark web site 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 web site, and naturally the 2 websites can’t talk…and so they invite me to name again.
However as a result of I’m a sucker for punishment I strive once more, and see if I can determine another approach within the Blue Defend web site. There I discover a drug pricing instrument.
I want to know the associated fee to me of shifting to the CVS Mail order. The instrument is aware of the medication I’m on! I ask it for the worth 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 through 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 stuffed (I assume primarily based on the declare from February) to see what the pricing is through mail order.
And naturally you may guess what the response is.
The reply is that 90 days provide shouldn’t be accessible in a retailer and apparently neither is 90 days provide accessible through mail order. And for this fabulous expertise they wish to cease me utilizing Alto Pharmacy. Presumably they need me to pressure my physician’s workplace to resubmit the Rx to CVS mail order.
In case you are nonetheless preserving rating, someplace between Blue Defend and CVS Caremark, for a upkeep drug that they wish to encourage me to be on (I assume), which prices them virtually nothing to accumulate, they need me to alter pharmacy and/or hassle my physician.
We nonetheless gained’t know if it really works, and for that matter it’s not sure who will get the additional $116 if I’m going again to 30 days at Alto.
And naturally it could be simpler and cheaper for me to pay the $11 + transport it could price 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, gained’t know what medication I’m on.
I hope you’ve loved this little journey by means of this obscure nook of the American well being care system. Bonus factors for those who can clarify why anybody would wish to undergo this, or what the hell Blue Defend or CVS Caremark are gaining for making me do it.
