Express Scripts is Terrible

[gindie]

I just called ES and the rep was helpful, as long as everything plays out the way she said it would. First, she authorized a 5-day supply I can pick up at my local pharmacy at no charge

I hope you have better luck with this than I did. My local pharmacy said "I wish they would stop telling people that!" Somehow, their "authorization" never made it to my pharmacy.

 

[iac1003]

When I was in private practice, ES would fax me a prescription request and I would fax it back and get a fax confirmation. But well more than half the time they would say they never got it - 2-3 weeks later when patients would call me to say they didn't get their prescriptions. I stopped faxing to ES and gave my patients paper prescriptions after this happened too many times and told them to mail it in themselves. That seemed to work only slightly better.


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[ExFlyBoy5]

I've been using ES for about 3 years and have NEVER had an issue. Even when there was confusion about refill/New script, they fixed it with no issues. I think the key is to have a doc that uses the online system and not phoning it in. For the most part, when my doc writes a new script, I have an email from ES saying it's being processed before I get out to the parking lot.

Sent from my mobile device so please excuse grammatical errors.

 

[meierlde]

Interestingly the problem I had was getting the local Wal-Mart to make contact with my Doctor to authorize the new refills. Found it works better to just call the Doctors office for a new scrip. (He does electronic prescriptions so they need to know where to send them). Interestingly on Express Scripts Medicare part D plan, they just charge a bit more for a 3 month supply if you buy it locally. Of course several of my medications fall on the Wal-Mart $10 list so before I reached 65 I just paid directly.

 

[MRG]

When I was in private practice, ES would fax me a prescription request and I would fax it back and get a fax confirmation. But well more than half the time they would say they never got it - 2-3 weeks later when patients would call me to say they didn't get their prescriptions. I stopped faxing to ES and gave my patients paper prescriptions after this happened too many times and told them to mail it in themselves. That seemed to work only slightly better.


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Interesting comment at least to me. One of the items I w*rked on was a home grown fax product it used a popular 3rd party product to drive the fax and would integrate into our system. Faxes would sometimes get lost for a variety of reasons, mostly because the APIs had no return codes to indicate failure. I recall this vendor used to claim that 30% of all faxes were lost, they never provided a source for that stat. We joked it was 30% of faxes that went through their software.

But if it's only slightly better with paper that kind of says it's maybe not the fax.

 

[eytonxav]

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!

 

[ziggy29]

I have CVS Caremark mail order and I was very surprised how efficient they are. The only glitch I had was when I needed doctor's authorization for a refill and they sent an email and left a voice message stating they had not received it from the doc. I called doctor's office and everything went smoothly again. I would heartily recommend CVS Caremark.

Good to know. I'm still pondering decisions for open enrollment, and it looks like most of the FEHB plans are using Caremark.

 

[MichaelB]

My mother used Medco, merged into Express Scripts. They really were impossible to deal with, we were unable to get some medicines replaced in a timely manner after some went missing. I went to the local Target, much to my surprise, the cost was lower for every one of her prescriptions and the Target pharmacy people were much easier to deal with.

 

[savory]

This has been my experience with ES.

DW and I have had ES for over 15 years with no troubles other than the " press one for Spanish, etc." The only trouble I have had with prescriptions is that ES prefers prescriptions be sent via email or fax. My family physician's policy is written or phone order prescriptions, so I have to be right on top of my physician's a$$, I mean staff, at refill time as not to screw up ES prompt service.

 

[braumeister]

We've used ExpressScripts for many years (they are the default with Tricare) and never had a problem that wasn't easily resolved.

A few months ago, they were even nicely proactive. DW has a permanent maintenance med and it was soon going to be time to renew it for another year. ExpressScripts contacted her doc on their own to ask if it was OK to renew it. The doc said yes, the scrip was renewed, and they called DW to inform her that she didn't need to ask the doc for the renewal.

I call that excellent service.

 

[ERD50]

I'll add that my previous comments saying I've never had a problem with any of the mail-order pharmacies was not meant in any way to be dismissive of the problems the OP or others have experienced. I know it's frustrating when you run into problems, and especially when it's tough to get resolution to those problems.

But one point I meant to make is that it might not make sense to try to jump ship due to this problem. I'm pretty sure you will find both horror stories and satisfied customers among all the places. I don't know if there is any wide-ranging customer satisfaction surveys out there, but I'd trust those more than anecdotes on either side (including my own - maybe I just got lucky?).

-ERD50

 

[Theseus]

I've learned not to count on the drug provider / doc communication link to get this done. Each of those two will always point the finger of blame at the other when communications breaks down. When I run out of authorized refills for a prescription, I contact doc myself.

+1
I've used Medco/Express Scripts for quite a few years as well, with I think 4 different insurance companies. Thee were some communications issues between docs and the mail order pharm in previous years, but I'd say that has been resolved in the last 3-4 years. I think it may have more to do with the ability of the doc to submit info on their terms, i.e. using Electronic Health Records Software that plays nice with their systems.

 

[Dash man]

I had a few problems with ES a few years ago, but they've all been worked out. I think most of the problems have been getting the doctors offices system to talk with the ES system. Haven't had a problem in a while now.


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[sengsational]

BCBSNC uses Prime Therapeutics. Seems about the same marginally acceptable level of service as Express Scripts or Medco (used both of them when on megacorp plan).

...and gave my patients paper prescriptions after this happened too many times and told them to mail it in themselves...

This is the route I try to use. And when I mail it, I use a tracking number. I print postage with tracking number using https://www.paypal.com/shipnow btw, which I think is great. Usually costs less than a buck and a half, and might get your letter a little more focus. Besides, you've can say it was delivered to X address at 12:42PM Thursday when you have the annoying do-nothing reps on the phone.

 

[HFWR]

No problems with Medco/Express Scripts, yet...

 

[ERD50]

For those suggesting that mailing in paper is best, does your Doc have a direct electronic link (not just a 1980's era FAX system) to the mail-order pharmacy?

IME, the direct link is great - I get confirmation within hours, often by the time I get home. No more than 24 hours in any case I can recall. It's no effort on my part, the Doc clicks a few buttons, and I get the closed-loop confirmation quickly - I can't imagine how snail mail would be preferred to this.

I suspect the problems people are talking about are with FAX based systems - FAX doesn't really have much (any?) of a closed loop control on it, so problems may go undetected until you realize you haven't seen any shipping notices, or your pills never show up.

-ERD50

 

[Sarah S]

Slightly off the subject should you ever have to have a prescription that Express scripts considers "specialty" (aka expensive) and you have a choice of specialty pharmacies google them before you pick. I did not and paid for it by running out of the medicine I take for a life threatening condition. They swore they had shipped it finally just in time after over a month of delays. It never came and by the time I realized they had lied there was a delay in getting it locally for cash because it had to be ordered by the pharmacy here. I then tried my other specialty pharmacy option and it arrived in less than a week. I only did the search afterwards and found many other stories like mine and involving life or death type drugs as mine was ( chemotherapy for cancer was common including chemo for young children).

 

[MRG]

For those suggesting that mailing in paper is best, does your Doc have a direct electronic link (not just a 1980's era FAX system) to the mail-order pharmacy?

IME, the direct link is great - I get confirmation within hours, often by the time I get home. No more than 24 hours in any case I can recall. It's no effort on my part, the Doc clicks a few buttons, and I get the closed-loop confirmation quickly - I can't imagine how snail mail would be preferred to this.

I suspect the problems people are talking about are with FAX based systems - FAX doesn't really have much (any?) of a closed loop control on it, so problems may go undetected until you realize you haven't seen any shipping notices, or your pills never show up.

-ERD50

+1

I've never been in express scripts location but I spent too much time in other large mail centers. These places are amazing but... Many receive pallets of mail from USPS, there is a certain amount of sophistication and planning involved to receive that volume and process it, without it getting thrown out. That's no joke the places that deal with huge volumes always have an issue regarding how do you know all the mail got received and into the systems. I've heard all kinds of horror stories on how hourly employees can become very creative at losing work. These horror stories came from people willing to sign off on large development projects $$ to eliminate the issue.

Not that it can't be done with tools and processes, but of you can avoid a manual step often times helps. That same issue occurs in many paper intense business transactions.

 

[youbet]

For those suggesting that mailing in paper is best, does your Doc have a direct electronic link (not just a 1980's era FAX system) to the mail-order pharmacy?

IME, the direct link is great - I get confirmation within hours, often by the time I get home. No more than 24 hours in any case I can recall. It's no effort on my part, the Doc clicks a few buttons, and I get the closed-loop confirmation quickly - I can't imagine how snail mail would be preferred to this.

I suspect the problems people are talking about are with FAX based systems - FAX doesn't really have much (any?) of a closed loop control on it, so problems may go undetected until you realize you haven't seen any shipping notices, or your pills never show up.

-ERD50

You're completely missing the point. People are not suggesting snail mail is more reliable than fax or IME. They're suggesting that not 100% turning over the task of securing a prescription renewal to the drug provider is best. Go see the doc yourself and get a new prescription, especially with critical drugs where missing a few days would be a big deal.


The common link in most of the mail order drug supplier horror stories seems to be failures in the process where the drug supplier contacts doc directly (often via IME) for a renewal but does not get a prompt response. In my case, doc wanted to see me before extending the prescription to draw blood and get some data. But noooooo..... he gets a request from a third party to extend the prescription before he hears from me. Now it's turning into a party game. I need my prescription renewed and tell the drug company via their web site. The drug company requests an extension from doc via IME. Doc pulls my file and refreshes himself on my status and decides he wants to see me first. He responds to the drug company. The drug company, not in the business of relaying detailed messages, just sends me a form email saying doc won't renew the prescription. WTF? It's Friday. I call doc's office Monday and plead for mercy but he insists he needs/wants test data and will not blindly renew. I get an appointment for the next day. Several days after that we have test results and doc writes me a new prescription.


Assuming that because doc wrote the prescription for drug X once, he'll renew it again and again without seeing you works sometimes, but not always. When doc doesn't renew and the communications is being relayed via the mail order drug provider, things bog down.


Lesson learned. Now I just make an appointment and go in when I need prescription renewals. I've been walking out with paper prescriptions but I'd be OK If I could watch him or his assistant submit via IME. (There's nothing magic about using US Mail other than I'm in the communications stream and not relying on a third party to keep me informed of what my doc is saying/doing.) The point is having knowledge of what's going on and being in control as opposed to turning the process over to the drug provider and hoping for the best until you hear otherwise.

It has NOTHING to do with fax, snail mail or IME being more reliable. It does have to do with control and having direct vs relayed communications.

When I rely on the drug provider to contact my doc with a refill authorization request, I'm stepping back from a process which would likely take some time and which I will not know the results of until something goes wrong. Pharma contacts doc for refill authorization. Doc either promptly drops everything, has your file pulled, reviews your situation and makes a decision of whether to renew or not. Or doc's system is such that someone else pulls your file and just gives him a summary. Or doc does these requests every other Thursday so you'll have some time to wait. Or..... whatever. You just sit back and wait to see how it works out.

When I go into the office with an appointment and ask doc for a new prescription and walk out with paper, I'm in control. I make a copy of the prescription and send the original in via snail mail. Despite the vagaries of the Post Office, I've never had an issue.

Again, no one here is talking about the technical superiority of electronic communication formats. The discussion is about getting prescription refill authorizations done. OP had an issue when he counted on the drug provider to contact his doc for him (I have too). Now I just coordinate needing refill authorizations with semi-annual trips into see doc and use paper and snail mail keeping myself in the loop.

In my case, doc is close by and I carry zero deductible, zero co-pay insurance so only my time is at issue.

 

[ERD50]

You're completely missing the point.

It has NOTHING to do with fax, snail mail or IME being more reliable. It does have to do with control.

When I rely on the drug provider to contact my doc with a refill authorization request, I'm stepping back from a process ....

I think there are two issues being discussed, and likely getting crossed. The one I was addressing in that post was that IME (In My Experience), the closed-loop electronic connection between Doc and mail-order pharmacy has been superior to snail-mail and/or FAX.

The other issue is what you describe with the pharmacy contacting Doc for refill authorization, and you are out of the loop - that's a potential problem, for all the reasons you mention.

Here's what my Doctors have done - they electronically submit the 'script, and at the time they submit it, they specify the number of refills they are authorizing. So 3-4 weeks before I'm out on the initial 'fill', and while I have a valid refill, I just go on-line and click 'refill' and they send it to me, usually within 24 hours, and I get shipping confirmation and tracking number by email. My Doctor is not involved in the refill process - the Doctor authorized it upfront.

This process seems to alleviate the problems being discussed here, for the most part? Maybe people here should check with their Docs to see if they can specify the number of refills at the time they submit the 'script, and verify that they can trigger the refill themselves? I think my mail-order pharmacy also allows an 'auto-refill' - they will ship when they estimate you need it, but I'd rather control that timing myself.

-ERD50

 

[ziggy29]

The common link in most of the mail order drug supplier horror stories seems to be failures in the process where the drug supplier contacts doc directly (often via IME) for a renewal but does not get a prompt response.

As a postal clerk I'll add another one.... pharmacies that don't include tracking on the medications they send, and inevitably someone will complain about not receiving their medicine which was sent in an untracked parcel, and there's almost nothing we can do to help the customer find it, or have any idea where it was last seen.

This is particularly galling since it's been well over a year since *all* package services through USPS receive tracking at no additional charge, and they *still* send medicine untracked. No excuse for sending medicine untracked, IMO, save for laziness.

 

[ERD50]

youbet: A little more detail on one point (you may have edited your post while I was replying - and I edited mine a bit as well):

My Docs have normally wanted a blood test before issuing a new 'script, but they have generally written each new 'script for a 90 day supply, with one or two 90 day refills specified upfront on that 'script. So there is never a case where the Doc will say he won't allow the refill w/o a blood test, because he already pre-approved X refills.

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

 

[ERD50]

As a postal clerk I'll add another one.... pharmacies that don't include tracking on the medications they send, and inevitably someone will complain about not receiving their medicine which was sent in an untracked parcel, and there's almost nothing we can do to help the customer find it, or have any idea where it was last seen.

This is particularly galling since it's been well over a year since *all* package services through USPS receive tracking at no additional charge, and they *still* send medicine untracked. No excuse for sending medicine untracked, IMO, save for laziness.

Seems I've always got a tracking #. I just checked on mine, due to be here tomorrow the 10th, from my Doc appointment on the 5th. So 5 calendar days from seeing the Doc, which is 3 business days. Pretty good.

-ERD50

 

[youbet]

Here's what my Doctors have done - they electronically submit the 'script, and at the time they submit it, they specify the number of refills they are authorizing. So 3-4 weeks before I'm out on the initial 'fill', and while I have a valid refill, I just go on-line and click 'refill' and they send it to me, usually within 24 hours, and I get shipping confirmation and tracking number by email. My Doctor is not involved in the refill process - the Doctor authorized it upfront.

Yes, you've described the standard "original prescription + X refills" process. It's worked well for me for decades whether I'm using mail order, walk-in, phone-in or whatever. What OP is talking about is a breakdown in communication when his mail order drug provider attempts to go directly to his doc to get additional refills beyond the original number and the request is not promptly authorized or other complications arise, such as doc wanting tests done.

This process seems to alleviate the problems being discussed here, for the most part? Maybe people here should check with their Docs to see if they can specify the number of refills at the time they

No, not at all. What you've described is the decades old process of doc writing a script with designated number of refills. That's never been a problem that I know of. Today's problem is that when the designated number of refills has been utilized, can you trust the system where you authorize the mail order drug provider to request directly from your doc authorization for additional refills? This is where the problem seems to pop up as in OP's case. I've learned to go to doc myself and get a fresh prescription. This gives him a chance to review my case, do additional testing or at least look me over and ask me how I'm doing on the drug. [/QUOTE]

 

[ziggy29]

Seems I've always got a tracking #. I just checked on mine, due to be here tomorrow the 10th, from my Doc appointment on the 5th. So 5 calendar days from seeing the Doc, which is 3 business days. Pretty good.

It's usually the smaller, local pharmacies that do mail order who don't do it. The big players always do. I think what they do is just use their own postage meter in-house, weigh the package and put a meter strip on it. Then they just give it to the mailman when the incoming mail is delivered. At least that's what I suspect they do.