Mail Order Pharmacy

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whr19606
Posts: 44
Joined: Sun Sep 30, 2007 6:50 am

Mail Order Pharmacy

Post by whr19606 »

Could use some help or advice in handling a mail order pharmacy that insists on sending me expensive brand name medicines instead of cheaper generic medicine.

Have been retired for 8 years and using a Medicare Part D pharmacy plan. For 2020,to save some money, I switched plans and got into a Mutual of Omaha/Express Scripts plan. Big mistake. When my provider prescribed a generic Tier 2 medicine for me (should cost $6.00 for 90 days), the pharmacy instead sent me only 30 days supply of a brand name drug that cost $43.40.

When I called Express Scripts to find out why, I was told that to get the generic, my provider has to mark the prescription "Dispense as Written". I called my provider and she then sent them a prescription for 90 days of the generic and noted "Dispense as Written". The pharmacy again sent me a 30 day supply of the brand name drug and charged me $43.40 again.

When I called Express Scripts again to find out why, they got a 'pharmacist' on the line and she said that the brand name medicine is THEIR preferred medicine. She said to get the generic, my provider has to mark the prescription "Dispense as Written", AND specify the drug manufacturer. I never heard of that before, but I called my provider and she sent them another prescription for 90 days of the generic "Dispense as Written", manufactured by Mayne Pharma. I am concerned that I'm getting the run around just so the pharmacy can increase its profits at my expense. I have been told that even if the pharmacy once again sends me the more expensive brand name drug, I cannot switch plans until 2021. That could result in me paying $520.80 this year for a medicine that should cost only $24.00.

Has anyone encountered anything like this before? Does anyone have any ideas as to how, and to whom, I can appeal this situation or to apply for a refund of the overcharges I have already paid? Thanks in advance for your assistance.
adamthesmythe
Posts: 3935
Joined: Mon Sep 22, 2014 4:47 pm

Re: Mail Order Pharmacy

Post by adamthesmythe »

Interesting. I don't have a Medicare drug plan right now but when I do I will be putting ExpressScript on my black list.

Clearly they are resisting selling you the generic by all the excuses they can think of. Slimy.
Seasonal
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Joined: Sun May 21, 2017 1:49 pm

Re: Mail Order Pharmacy

Post by Seasonal »

We had an issue with ExpressScripts and generics. My wife got a notice that they were going to fill a generic prescription with a much more expensive brand name. She immediately cancelled the order. She was told the doctor had to re-submit with "dispense as written", did so and they sent the generic.

I'd ask to speak to a supervisor at ExpressScripts and I'd call Medicare and your state insurance regulator and see what they suggest.
scrabbler1
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Joined: Fri Nov 20, 2009 2:39 pm

Re: Mail Order Pharmacy

Post by scrabbler1 »

I had to change insurance plans starting in 2016 due to Express Scripts being so awful with my diabetes medication. They were sometimes late mailing it to me because they couldn't get proper authorization from my doctor. But when I called my doctor's office, they told me they faxed the authorization over and over to them, and that EX-S often gave their patients problems with these delays. If I wanted to dump EX-S but remain in my insurance plan, I would have to buy the expensive drugs myself. So, I dumped the plan and EX-S. I can now pick up my covered meds at the local CVS without all the aggravation.
Farmboyslim83
Posts: 121
Joined: Sun Oct 07, 2012 12:06 pm

Re: Mail Order Pharmacy

Post by Farmboyslim83 »

Walmart or Costco might have a cash price that is much lower. You wouldn’t be using your prescription card. Express Scripts might be getting a rebate on the drug they keep sending you, you will never know that. Worth a call to Walmart or Costco.
vested1
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Joined: Wed Jan 04, 2012 4:20 pm

Re: Mail Order Pharmacy

Post by vested1 »

It's likely that you will continue to be stonewalled by the insurance company. I would suggest that you make a formal Medicare complaint, which all insurance companies dread, as their ratings by Medicare depend on satisfying their customers.

https://www.cms.gov/Medicare/Appeals-an ... Grievances

I was having problems with my new Medicare Part D provider, which was actually the same one as last year under a different name, having had been bought out by a giant drug conglomerate. After trying several attempts on the phone to get the problems resolved, I issued my formal complaint to medicare, and informed the insurance company that I had done so in a separate email. My complaint got the immediate attention of the company and I was assigned a case number and a personal representative to resolve it.

In my case, I paid a full year's premium for 2020 on 12/17/19, using the payment book they had sent me, and the check I sent was cashed on 12/26/19. The insurance company then started sending me snail mail saying since I hadn't chosen how to pay the bill that they were having my monthly premiums taken out of my SS check. It got worse and worse every time I called as they kept making additional mistakes, sending me partial checks when I asked them not to and quoting me wildly different rates for the same plan, some 5 times what the rate actual was.

They even refused to honor my valid prescriptions which were to be filled by the same mail order firm (CVS), even though I had refills available which they could see in their system. They required me to have the prescriptions reordered by my doctor who charged me $15 a prescription to do so, because it was between office visits. After I filed the complaint and got everyone's attention they not only filled the new prescriptions but the old ones too, so now I have enough prescriptions for almost a year.

Unfortunately it sometimes takes dogged persistence to get an issue like yours resolved, but don't give up.
Seasonal
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Joined: Sun May 21, 2017 1:49 pm

Re: Mail Order Pharmacy

Post by Seasonal »

It's also worth seeing if GoodRx has a coupon that would get you a lower price, although it wouldn't count against your deductible.
Jack FFR1846
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Re: Mail Order Pharmacy

Post by Jack FFR1846 »

In my state, they have to use a generic unless expressly written "no substitutions" on the script.

I'm fortunate that we can use CVS in plan and get 90 day supplies. Not having to deal with Express Scripts (been there) or Optum (incompetent in every way) has been good.
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fru-gal
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Re: Mail Order Pharmacy

Post by fru-gal »

vested1 wrote: Wed Feb 19, 2020 1:40 pm It's likely that you will continue to be stonewalled by the insurance company. I would suggest that you make a formal Medicare complaint, which all insurance companies dread, as their ratings by Medicare depend on satisfying their customers.

https://www.cms.gov/Medicare/Appeals-an ... Grievances

I was having problems with my new Medicare Part D provider, which was actually the same one as last year under a different name, having had been bought out by a giant drug conglomerate. After trying several attempts on the phone to get the problems resolved, I issued my formal complaint to medicare, and informed the insurance company that I had done so in a separate email. My complaint got the immediate attention of the company and I was assigned a case number and a personal representative to resolve it.

In my case, I paid a full year's premium for 2020 on 12/17/19, using the payment book they had sent me, and the check I sent was cashed on 12/26/19. The insurance company then started sending me snail mail saying since I hadn't chosen how to pay the bill that they were having my monthly premiums taken out of my SS check. It got worse and worse every time I called as they kept making additional mistakes, sending me partial checks when I asked them not to and quoting me wildly different rates for the same plan, some 5 times what the rate actual was.

They even refused to honor my valid prescriptions which were to be filled by the same mail order firm (CVS), even though I had refills available which they could see in their system. They required me to have the prescriptions reordered by my doctor who charged me $15 a prescription to do so, because it was between office visits. After I filed the complaint and got everyone's attention they not only filled the new prescriptions but the old ones too, so now I have enough prescriptions for almost a year.

Unfortunately it sometimes takes dogged persistence to get an issue like yours resolved, but don't give up.
I probably shouldn't tempt fate, but I'll say I've never had these kinds of problems with Plan D AARPMedicareRX. Also, I do make one annual payment with no fuss from them.
AmandaH
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Joined: Sat Dec 24, 2016 3:16 pm

Re: Mail Order Pharmacy

Post by AmandaH »

I'm not on Medicare but use Express Scripts for mail away ongoing medications. One of them I want only a certain generic manufacturer because the others make me ill. My doctor writes the script "XXXX" brand only. I always get the right one.

Regards,
Amanda
vested1
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Joined: Wed Jan 04, 2012 4:20 pm

Re: Mail Order Pharmacy

Post by vested1 »

Farmboyslim83 wrote: Wed Feb 19, 2020 1:35 pm Walmart or Costco might have a cash price that is much lower. You wouldn’t be using your prescription card. Express Scripts might be getting a rebate on the drug they keep sending you, you will never know that. Worth a call to Walmart or Costco.
It depends on the particular store. My wife needed a prescription outside of her regular and recurring mail order prescriptions for a temporary problem. Her Medicare Part D plan required her to go to Walmart to get the prescription filled, and she needed it right away.

We were surprised that it was $65 for a 30 day supply, and when she mentioned this to her doctor on the follow up visit, the doctor replied that the particular Walmart we went to had a habit of filling prescriptions that called for the generic with the non-generic version in order to make more money from the prescription. The drug name on the prescription was for the generic and it was filled with the non-generic, even though they had both in stock. When my wife asked the Walmart druggist why it was so expensive he replied that the prescription called for the non-generic version and he had no choice.
vested1
Posts: 2326
Joined: Wed Jan 04, 2012 4:20 pm

Re: Mail Order Pharmacy

Post by vested1 »

fru-gal wrote: Wed Feb 19, 2020 1:45 pm
vested1 wrote: Wed Feb 19, 2020 1:40 pm It's likely that you will continue to be stonewalled by the insurance company. I would suggest that you make a formal Medicare complaint, which all insurance companies dread, as their ratings by Medicare depend on satisfying their customers.

https://www.cms.gov/Medicare/Appeals-an ... Grievances

I was having problems with my new Medicare Part D provider, which was actually the same one as last year under a different name, having had been bought out by a giant drug conglomerate. After trying several attempts on the phone to get the problems resolved, I issued my formal complaint to medicare, and informed the insurance company that I had done so in a separate email. My complaint got the immediate attention of the company and I was assigned a case number and a personal representative to resolve it.

In my case, I paid a full year's premium for 2020 on 12/17/19, using the payment book they had sent me, and the check I sent was cashed on 12/26/19. The insurance company then started sending me snail mail saying since I hadn't chosen how to pay the bill that they were having my monthly premiums taken out of my SS check. It got worse and worse every time I called as they kept making additional mistakes, sending me partial checks when I asked them not to and quoting me wildly different rates for the same plan, some 5 times what the rate actual was.

They even refused to honor my valid prescriptions which were to be filled by the same mail order firm (CVS), even though I had refills available which they could see in their system. They required me to have the prescriptions reordered by my doctor who charged me $15 a prescription to do so, because it was between office visits. After I filed the complaint and got everyone's attention they not only filled the new prescriptions but the old ones too, so now I have enough prescriptions for almost a year.

Unfortunately it sometimes takes dogged persistence to get an issue like yours resolved, but don't give up.
I probably shouldn't tempt fate, but I'll say I've never had these kinds of problems with Plan D AARPMedicareRX. Also, I do make one annual payment with no fuss from them.
My wife and I have AARP United Health Care Part N, which is great. We had the option of going to Medicare Advantage this year in our new State of residence, but after looking at the maximum out of pocket, copays, and deductibles we stayed with the same plan through her previous employer. Our Part D is through my previous employer. We need to have coverage through both our previous employers to qualify for both HRA plans which provide over 12k in yearly reimbursement, which we max out due to my wife's prescriptions.

I have WellCare for my Part D and my wife has Humana. We have no trouble with Humana or Humana Specialty (tier 5 drug), it's Wellcare that's been the nightmare. They used to be Aetna before they were bought out and merged with many other companies, one of which is CVS from my understanding. In fact the number on the back of the Wellcare card goes to Aetna and CVS, although all three companies play the shell game of blaming any problems on the other one and their non-ability to see the other one's system. In my opinion this is by design.

As I posted in an earlier thread, my wife and I have to deal with 25 different entities for our health care now. We've been on Medicare for two years and I don't how "average" senior citizens, who aren't particularly good with detail are able to deal with this much complexity, or how they deal with it starting again all over at open enrollment when, like in our case, mergers and takeovers make choices even more difficult.
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OAG
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Re: Mail Order Pharmacy

Post by OAG »

Strange I have been using ES for over 15 years now. I get only 3 routine recurring prescriptions from two physicians and I get only generics. Under my medical plan the plan sets the price to me - for many years it was $0 per 90 day; the last year (2019) it was $7 per 90 day and this year 2020 it is $10 per 90 day. None of the increases in pricing were the fault of ES. FWIW ES has always been easy to deal with for me.
OAG=Old Army Guy. Retired CW4 USA (US Army) in 1979 21 years of service @ 38.
ustf
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Re: Mail Order Pharmacy

Post by ustf »

Seasonal wrote: Wed Feb 19, 2020 1:43 pm It's also worth seeing if GoodRx has a coupon that would get you a lower price, although it wouldn't count against your deductible.
+1
To make it count against my deductible, I filled out a Express-Scripts online "Prescription drug reimbursement form" after my Goodrx purchase and they went ahead and applied my paid amount towards my deductible
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praxis
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Re: Mail Order Pharmacy

Post by praxis »

Seasonal wrote: Wed Feb 19, 2020 1:43 pm It's also worth seeing if GoodRx has a coupon that would get you a lower price, although it wouldn't count against your deductible.
+1

good results with a Good Rx card that my doctor's nurse gave me on my last visit. They are available free on line.

https://www.goodrx.com/?gclid=CjwKCAiA1 ... q0QAvD_BwE

It beat my Humana mail order pharmacy price by a lot.
sport
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Re: Mail Order Pharmacy

Post by sport »

My Express Scripts Part D plan gives me the choice of mail order from ES, or go to a neighborhood pharmacy. The pharmacies are either "in network preferred", "in network", or "out of network". After some unhappiness with ES mail order, we switched to a local "in network preferred" pharmacy. We pay a little more, but it is worth the difference not to have to deal directly with ES. For drugs in the formulary, the prices for three months generic/brand name are $25/$75 from ES and $30/90 from the local "in network preferred" store. Sometimes we can lower prices at the preferred store.
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JoeRetire
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Re: Mail Order Pharmacy

Post by JoeRetire »

whr19606 wrote: Wed Feb 19, 2020 12:55 pmHas anyone encountered anything like this before?
No. Had Express Scripts for many years and never had a problem.
It's the end of the world as we know it. | It's the end of the world as we know it. | It's the end of the world as we know it. | And I feel fine.
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