Insurance providers requiring mail-order prescription refills in order to cover cost of medication

[ibegurpard]

This is something that is starting to happen more and more. I recently got a letter from the prescription management company (Express Scripts) stating that if I did not use their mail order pharmacy for my thyroid medication they would not cover the cost of it. Now the cost is nominal so it's not a hardship but I believe this a bullshit requirement and the cost of certain long-term medication for others can be staggering. I have been reading that New York had passed a law banning the requirement of mail-order prescription refills and want to know what people can tell me about the status of that as well as any similar legislation in other states.

[Hoyt]

1. I'm fine with developing ways to save money as long as a hefty portion is shifted

to us. But, not if anyone would miss a dose because of a technicality.

We are going to have to save every nickel however we choose to transition to a healthcare system that covers everyone at reasonable cost.

[ibegurpard]

4. proving it as an option is fine

requiring it is not. Too many drawbacks to mail order for something as important as medication: sent to the wrong address, stolen from mailboxes and porches (a real possibility with the opioid abuse epidemic), delays, and a further loss in local jobs are just a few off the top of my head.

[Ms. Toad]

11. With the curent restrictions on opiods, that's unlikely.

Express Scripts works on 90-day prescriptions; the rest is typically at a brick and mortar store, and 90-day opoid prescriptons are largely a thing of the past

We use mail order for any med more than 30 days in duration - including my daughter's $3-$6000 infusion meds.

[ibegurpard]

12. I'm talking about junkies seeing a package on a doorstep or in a mailbox and stealing it

they don't take the time to find out what's in it. I won't ever have packages of any sort sent to my home unless there's an option to hold for signature since I'm not there at mail delivery times. And if I have to go to that trouble then it's better to get it in hand at my pharmacy.

[unc70]

2. Also things like CVS now owning Aetna

[Corgigal]

3. Only way I get my meds from the VA.

I go online, click refill. In a week, it’s in my mailbox and cost nothing. I take thyroid medication, refill every 3 months. While it should be up you, if you have to do it. You’ll get use to it , it’s not that bad.

It use to cost me 7 dollars a month for refills. Obama changed something in the VA system, it’s free now.

[ibegurpard]

6. Yes it should be up to me

And I won't use it. the medication cost for this one is nominal...what about those with recurring prescriptions where it isn't?

[Corgigal]

7. That's what I have.

I just get a refill before I run out. I have no option, and while my husband gets his meds at a local pharmacy, I don’t mind the mail. I even can track it and know when it arrives. Been taking the same med for 18 years. Never ran out.

[Coventina]

5. They don't want you to be talking your pharmacists or techs. n/t

[Ms. Toad]

8. You might explore that a bit more

I had a simlar experience with thyroid medication and express scripts recently - while we were still in the adjustment phase and did not yet know what my dose would be more than 30 days out. They refused to fill it at the pharmacy, but it turns out that I just had to go to the pharmacy and decline mail order. So it was a royal pain (I would have had to do that every month) - but it was not a ban on coverage as much as an in person opt out program.

FWIW - unless my meds are short term, we prefer mail order. Generally no hassle, we don't run out or have to remember to reorder meds.

As for Express Scripts - we had no problems with their fulfillment. BUT I'm very wary of their record privacy, and would avoid them if I had the option.

My spouse - out of the blue, a few years after were no longer on the Express Scripts plan - started receiving email notices that she needed to provide alternate payment information for a medication she's never taken. We thought it was a scam - and that the scammer coincidentally landed on someone who had at one point been an Express Scripts client. Until the medications ended up on our doorsteps a few days later - medications which told us whoever they were intende for was mentallly ill.

Turns out my spouse has a double - same name (including middle initial) and same birth date (including year). So when the new client signed up for Express Scripts they pulled up my spouse's records, linked the two accounts, and started using all of the old contact information for my spouse when their efforts using the new person's contact information failed. We then had access to all or her medical information via the online portal (which was reactivated since they believed my spouse was once again their client). It was a nightmare to sort out - since they started out refusing to believe they had made an error - and then refused to give us any means to verify that they had not given my spouse's information to their new client. And they didn't really seem to care about their pretty significant HIPAA vioation.

[ibegurpard]

10. I can and do continue to refill mine at my local pharmacy

the problem is that since they won't cover it it doesn't count toward my deductible and out of pocket limits.

[Ms. Toad]

13. I'm suggesting you have a conversation with your local pharmacist.

Same company. Same routine. But it turns out that all Express Scripts required to cover it at the pharmacy was for me to physically show up at the pharmacy, override the mail order (mandatory) opt in and wait while they filled it. Express Scripts woudn't tell me that when I read them the riot act - BUT - they told the local pharmacy what I had to do to continue to pick up that prescription at the pharmacy.

[ibegurpard]

14. thanks I will see what the pharmacy says about it next time i go in

[csziggy]

9. The problem I had with mail order prescription refills was non-compliance

With what the doctor ordered. After my hysterectomy my doctor prescribed a hormone patch. The first time I got it filled, they substituted a generic - which I am normally OK with but this one did not release the hormones at a steady rate. This gave all sorts of problems, including the debilitating migraines which was one of several reasons I got the hysterectomy.

I did some research and found that the original manufacturer of the patches had sued the generic manufacturer and had an appeal with the FDA because of the problems with the generic. My doctor wrote a new prescription requiring ONLY the original brand name patch which did not give me problems.

The mail order company ignored that and sent a three month supply of the generic. I protested and they sent the brand name - but insisted that I pay full price for the specified medication and would not refund me for the incorrect order.

Even though it cost me more, until I stopped using the hormone patches I got them filled locally. That meant if they substituted the generic I could get it replaced immediately without having to wait for a correction and pay much more out of pocket.

As for the mail order company, I ended up filing a complaint with the Texas (location of the mail order pharmacy) board that governed the industry. Nearly three years later I got a check for the full amount of both prescription orders.

The mail order pharmacy - Express Scripts.