Express Scripts is Terrible

[youbet]

Now when I need that new script, I know he's likely to want a blood test, since he didn't get one for the past refills, so I allow a little more time for that phase of the cycle. Though for me at least, he's always written the 'script, and checked the blood work after the fact. I assume he'd call and let me know if he saw issues.

-ERD50

OK, this sounds like you're agreeing with me. Like me, you'd go to your doc's office and have him write a new prescription rather than authorizing the mail order drug provider to contact him (via EME or whatever) to authorize additional (beyond the number on the original prescription) refills.

This has been standard for as long as I can remember (which is a really long time).

The new issue, which you seem to be struggling to get your head around, is that now drug providers encourage you to allow them to contact your doc directly and ask for additional refill authorizations when you've run out of the number allowed on the original prescription. I've learned not to do that.

 

[ERD50]

EDIT - I think I missed your post #49...

So let me update this - So what I'm missing is - why not just do the "standard "original prescription + X refills" process" that we are both describing? MAybe I'm misreading, and you are doing that, but I'm not sure about the OP.

Bottom line, it seems we are saying the same thing - get out from the MO Pharm contacting the Doctor for refills. What I'm not sure we are on the same page on is - are we all able to get the Doc to write the " the standard "original prescription + X refills" process."?

OK, we are agreeing - get the new script when 'pre-approved' refills are out. I guess it wan't clear to me if OP was getting those pre-approved refills, or not.

-ERD50

OK, this sounds like you're agreeing with me. ...

The new issue, which you seem to be struggling to get your head around, is that now drug providers encourage you to allow them to contact your doc directly and ask for additional refill authorizations when you've run out of the number allowed on the original prescription. I've learned not to do that.

Yes. But on the 'new' issue - all I can say is what I put in those other posts - my Doc submits the 'scripts with X refills noted, so they are essentially pre-approved, and my mail-order pharmacy has no reason/need to contact the Doc for a refill. That circumvents the issue, right?

Now once the pre-approved refills are 'used up', yes, I go to the Doc for a new 'script, which he will again write with 2-3 pre-approved refills (and order a blood test if he wants).

It sounds like you are going back to the Doc for every fill, so that every refill is essentially a 'new' 'script? Would your Doc do the pre-approval of one refill like my Docs do, so that you could cut that effort in half, and your Doc still has an opportunity every six months (assuming 90 day mail-order fills/refills) to ask for a blood test?

Just seems easier on everyone.

-ERD50

 

[Car-Guy]

We originally had Medco. When the merger with Express Scripts took place, there was an immediate fall off in service and changes in policy. They suck!

BINGO! +1 or 2

DFW, maybe they have it in for those of us who live in Texas? We had Medco too before they merged. Medco was OK. When you say "they suck", you are being far too kind. Why do these mega corps sign contracts with these idiots? (No need to answer that!)

What really makes me mad is they seem to get really close to practicing medicine or knowing better than your doctor. Don't believe it, just try ordering a brand name drug when a much cheaper generic is available and the doctors prescription says "do not substitute". I realize, some generics work ok (maybe) but many do not. They will try to force you to the cheaper drug regardless. YMMV

 

[youbet]

So let me update this - So what I'm missing is - why not just do the "standard "original prescription + X refills" process" that we are both describing? MAybe I'm misreading, and you are doing that, but I'm not sure about the OP. [

Yes, you are misreading. (And this is my last post on this since you seem to have a pre-conceived notion of what I'm saying that I can't change.) I am doing exactly what you are doing. I DON'T allow the MO provider to contact my doc directly for authorization to extend the original script beyond the number of originally authorized refills. This has eliminated my problems.

Bottom line, it seems we are saying the same thing - get out from the MO Pharm contacting the Doctor for refills.

Yes!

What I'm not sure we are on the same page on is - are we all able to get the Doc to write the " the standard "original prescription + X refills" process."?

I can't remember doing it any other way. When doc wants me to take a drug, he writes a prescription for an original quantity and X number of refills. I'm 68 yo and that's the only way I ever remember doing it.

Yes. But on the 'new' issue - all I can say is what I put in those other posts - my Doc submits the 'scripts with X refills noted, so they are essentially pre-approved, and my mail-order pharmacy has no reason/need to contact the Doc for a refill. That circumvents the issue, right?

Nope. The new issue is the the MO pharms want to authorize them to contact your doc to get an extension on the number of refills originally authorized. That keeps your business with them. It sounds convenient but apparently has pitfalls which we've been discussing in this thread.

When you're on your MO pharm's web site, doesn't it offer you an opportunity to let them get your prescriptions extended? For example, mine says something like: "Dear youbet, You have now used all refills on this prescription. Check this box and we'll contact your doc and get the prescription extended for additional refills. You need to do nothing!"

I checked the box. That's when the trouble started. So going forward, no box checking for me! I go and see doc myself.

It sounds like you are going back to the Doc for every fill so that every refill is essentially a 'new' 'script?

Absolutely not and I have been very clear in that regard.

Would your Doc do the pre-approval of one refill like my Docs do, so that you could cut that effort in half, and your Doc still has an opportunity every six months (assuming 90 day mail-order fills/refills) to ask for a blood test?

This is how it's done. Again, for the ninety-fifth time, the issue is with the MO pharma contacting doc to extend the number of originally authorized refills without the patient (me) being in the loop. I now reject this innovation. I've had too many issues.

 

[youbet]

BINGO! +1 or 2

What really makes me mad is they seem to get really close to practicing medicine or knowing better than your doctor. Don't believe it, just try ordering a brand name drug when a much cheaper generic is available and the doctors prescription says "do not substitute". I realize, some generics work ok (maybe) but many do not. They will try to force you to the cheaper drug regardless. YMMV

When you ask for a brand name in lieu of a equivalent generic and you say they try to "force" you to take the generic, what does that mean? They absolutely refuse to give you the brand name? Or they give you the brand name but charge you a higher price than the generic?

 

[Alan]

DFW, maybe they have it in for those of us who live in Texas?

I used ES for years in Louisiana before we moved to Texas and no problems. When I went to a doctor here to get examined and prescribed the same medicine I had been receiving in Baton Rouge he wrote me a paper prescription and I said, "Paper!! The doc in Baton Rouge simply asked me which pharmacies I used and put in the orders on his hand held device. First month supply at my local pharmacy, and then 90 day refills with ExpressScripts. "

All the problems I've had with ES are since 2010 when we moved back to Texas (Houston) and I was back to paper and fax.

 

[ziggy29]

When you ask for a brand name in lieu of a equivalent generic and you say they try to "force" you to take the generic, what does that mean? They absolutely refuse to give you the brand name? Or they give you the brand name but charge you a higher price than the generic?

Usually "they" (generically in terms of drug benefits) try to force you into the generic and refuse to cover the brand name unless there are medical reasons why the generic can't work for you. In such a case, you should be able to get the brand name but you would pay 100% of the difference in cost.

If a generic costs $5 (fully covered) and the "tier 2" name brand drug costs, say $100, if you insist on the name brand you will pay the $95 difference. But if you get it documented form your doctors that you can't take the generic for whatever reason and it's approved, you will have it fully covered, though you would still have a larger "tier 2" copayment or coinsurance, most likely, than for a "tier 1" generic.

 

[ERD50]

Yes, you are misreading.

...Nope. The new issue is the the MO pharms want to authorize them to contact your doc to get an extension on the number of refills originally authorized. That keeps your business with them. It sounds convenient but apparently has pitfalls which we've been discussing in this thread.

When you're on your MO pharm's web site, doesn't it offer you an opportunity to let them get your prescriptions extended? For example, mine says something like: "Dear youbet, You have now used all refills on this prescription. Check this box and we'll contact your doc and get the prescription extended for additional refills. You need to do nothing!" ...

There's the disconnect, I think.

No, I've never seen that 'opportunity'. Or maybe I just never noticed, as I knew my Doc would want another blood test done when he fills out the new script. He was big on a blood test every 6 -9 months, and would authorize 2-3 refills. So even if that 'opportunity' appeared - (and I don't recall seeing it, and I'm pretty sure it just told me I was out and needed a new script), I would have ignored it, knowing the Doc would reject it anyhow.

So don't hit a button and count on the MO Pharmacy to contact your Doctor and process an extension of the original prescription. Got it. And agree. Good advice.


-ERD50

 

[youbet]

Usually "they" (generically in terms of drug benefits) try to force you into the generic and refuse to cover the brand name unless there are medical reasons why the generic can't work for you. In such a case, you should be able to get the brand name but you would pay 100% of the difference in cost.

If a generic costs $5 (fully covered) and the "tier 2" name brand drug costs, say $100, if you insist on the name brand you will pay the $95 difference. But if you get it documented form your doctors that you can't take the generic for whatever reason and it's approved, you will have it fully covered, though you would still have a larger "tier 2" copayment or coinsurance, most likely, than for a "tier 1" generic.

Clear explanation. Thanks Zig.

I guess I'm comfortable with that. If anyone could order the expensive brand name instead of the generic equivalent just on a personal preference, I guess most folks would stick with the brand name. Premiums would have to go up. Brand name pharmas would make lots of profit.

As long as your doc can submit a requirement explaining why you need the brand name, the system seems OK. If we're talking true generic equivalents, the number of these should be minimal.

 

[youbet]

There's the disconnect, I think.

No, I've never seen that 'opportunity'.

-ERD50

Whew....... It's always a relief to finally discover the difference in inputs that's causing folks to be talking past one another.

 

[Walt34]

Enlightening thread. I've been getting grumpy if there are more than two people in line at the CVS pharmacy counter. I think this thread will help me chill a bit.

 

[Sue J]

Paper vs electronic.

I always get printed prescriptions because I come home and look them up on my insurances mail order site and then compare with local pharmacies via www.goodrx.com . With our insurer in 2014 most of them were less expensive at the local pharmacy, without using the insurance. For 2015 (different insurer) the mail order cost was less except for one of DH's Rxs so we used a GoodRX coupon and saved a few hundred dollars over what it would have been through the mail order pharmacy (Medvantx which changed to MedImpactDirect in Sept).

A few years/insurers ago we had Express Scripts for our mail order. It was fine except for excessive robo calls. "Your Rx is due for a refill" then "Your prescription has been processed" then another one for "Your prescription has been mailed". I finally shut that off by changing the settings in our account.

 

[Car-Guy]

When you ask for a brand name in lieu of a equivalent generic and you say they try to "force" you to take the generic, what does that mean? They absolutely refuse to give you the brand name? Or they give you the brand name but charge you a higher price than the generic?

As I said, they try to force you (through cost controls), but they don't refuse. They tell me how the generic is really the same thing (that's BS) and it's cheaper for them and for me (that part is probably true). Every time I renew the prescription, they call and write... As I said earlier, some generics probably do work.... I really don't know. I do know they don't "all" work as well. I do pay a premium (80%) for the brand name meds. And I know the 20% they pay is still more than the total cost of what the generic equivalent would be. I'm sure they are just trying to save "me" money.

 

[scrabbler1]

OP here. Yesterday, I picked up a 5-day supply of the drug at my local pharmacy. No charge, no problem. I will take the last pill of my current 1-month supply very shortly. The refill was mailed out via UPS so it will arrive in the next few days, presumably before the 5-day supply runs out.


Interesting discussion in this thread.

 

[FUEGO]

Agreed, express scripts is horrible. They claim they will stop covering our rx's if we get them from the retail pharmacy so we essentially have to order online. Ok.

I give them the RX info, then realize they only do 3 months at a time by mail and I just need 1 month. So I tell them to cancel my request for the 3 month mail order. They put in the request for 3 months to my doc. I have to call and cancel again. A week later I get the prescription in the mail. And a bill for it online. And it's name brand instead of the generic I was filling at the retail pharmacy (therefore even more expensive than paying cash at retail).

I call to complain, they eventually give me a refund and say keep the rx. I verify all other orders cancelled. 2 weeks later another order of the rx shows up (generic this time at least). I call to complain again and get another free rx.

Anyone need any prescription strength toothpaste? I have a few extra tubes.

 

[infoseeker]

Has anyone had concerns about the way Express Scripts packages the filled prescriptions for mailing?

My husband has a chronic condition that requires a control drug. Many controlled drugs have street value. At times, Express Scripts has sent this drug in a thin bubble pack envelope, with the pills rattling inside the bottle. .

Why cannot Express Scripts put cotton in the bottle (to stop the rattling) and disguise the shape of the bottle itself by mailing in a more rigid container? Or, require a signature at pick up, so it waits (safely?) at the post office? What the heck, I think they should do both!

 

[ERD50]

Has anyone had concerns about the way Express Scripts packages the filled prescriptions for mailing?

My husband has a chronic condition that requires a control drug. Many controlled drugs have street value. At times, Express Scripts has sent this drug in a thin bubble pack envelope, with the pills rattling inside the bottle. .

Why cannot Express Scripts put cotton in the bottle (to stop the rattling) and disguise the shape of the bottle itself by mailing in a more rigid container? Or, require a signature at pick up, so it waits (safely?) at the post office? What the heck, I think they should do both!

Have you asked them?

A long time ago, can't recall who the pharmacy was (Medco?), sent me some meds that were timed release, so had a coating, and no cotton, and some were broken. I called, they replaced them and packed with cotton from then on.
-ERD50

 

[scrabbler1]

Well, color me stunned! The 3-month pill supply from Express Scripts arrived this morning via UPS. Looks like all of my squeaky wheel antics paid off?

 

[W2R]

Well, color me stunned! The 3-month pill supply from Express Scripts arrived this morning via UPS. Looks like all of my squeaky wheel antics paid off?

Glad to hear it!

 

[youbet]

As I said, they try to force you (through cost controls), but they don't refuse. They tell me how the generic is really the same thing (that's BS) and it's cheaper for them and for me (that part is probably true). Every time I renew the prescription, they call and write... As I said earlier, some generics probably do work.... I really don't know. I do know they don't "all" work as well. I do pay a premium (80%) for the brand name meds. And I know the 20% they pay is still more than the total cost of what the generic equivalent would be. I'm sure they are just trying to save "me" money.

That seems fair enough to me! I do use generics and wouldn't want higher premiums forced on me so that others can chose brand name drugs. So we each get what we pay for.

Fortunately for guys like you and me, these cost variations are fun to talk about and do a little bitching and moaning, but they don't keep us from choosing what we want and paying the price without undo budget issues.