Express Scripts is Terrible

[scrabbler1]

My health insurer allows me to get an initial fill of a prescription drug and one refill before requiring me to use this mail-order outfit, Express Scripts, to fill subsequent refills or else I have to pay for the drugs myself. But my recent experiences with Express Scripts have been terrible.

The first time I needed a refill was mildly annoying because they supposedly "reached out to my doctor" for authorization to simply transfer to Express Scripts (why would they need that?) but my doctor did not receive any phone calls or faxes. It took several phone calls to both ES and my doctor to finally get the refill processed. Thankfully, I had begun the refill process about 2 weeks before I ran out of pills so I received the refill several days before I needed to take the first one.

The second time was far worse and has still not yet been fully resolved. I placed a refill for a drug back on October 27th (2 weeks before I would run out of pills) and once again, I received an email stating that ES had "reached out to my doctor" but got no reply. I had even warned my doctor's office that I had put in for a refill and to be on the lookout for any request. They received nothing. But this time, unlike the last time, this authorization process dragged on for so long that ES canceled the order so by the time the authorization arrived, they had to begin a new order, setting me back more. The new order was placed November 4th but I just got an email saying that it won't be ready to ship until Thursday, November 12th! Eight days just to process an order? I will run out of pills before the order is due to be shipped, which means I will have to get a short-term supply of the drug to hold me over, on my own dime. But with each day's pill costing me $10 it ain't cheap. I have already put into place with my local pharmacy this Plan B so I can pick up a week's supply before I run out of my current supply.

Although it probably won't do me any good, I will call my insurer and yell at them for forcing me into this crummy outfit which seems incapable of processing a refill order on a timely basis and thereby risking my running out of my drug or buying it on my own dime.

With open enrollment for ACA plans (mine is ACA) starting up, I will surely change to a new insurance company, one which doesn't require my using Express Scripts for my drugs, and one which covers some of my other prescription items (not very costly going into 2016) my current plan does not.

Anyone else here have trouble with Express Scripts processing and delivering drugs on a timely basis?

 

[youbet]

Some clarification please......

When you say "process a refill" are you saying that the prescription was in place, in Express Script's hands, and simply needed to have the pills counted out and shipped to you? That is, there were still open refills on the original prescription?

Or, are you saying that Express Script would need your doc's authorization to send you additional meds because all refills authorized on the original prescription had been previously executed?

 

[W2R]

Scrabbler, my sympathies. Dealing with anything having to do with prescriptions is so aggravating.

Recently I had cataract surgery on both eyes, one week apart, and each eye was to get its own set of the same 3 varieties of eyedrops to be administered for several weeks post-op. It wasn't allowed to use the same eyedrop container on both eyes, because of the risk of spreading any possible infection.

Yet, my insurance company at first REFUSED to pay their share for the second, separate prescription for the same medications for my right eye, because they had just filled the one for my left eye the week before. These prescriptions would cost hundreds of dollars without insurance chipping in. Luckily I got the lady at CVS to do the phone battle for me and after a day of repeated calling she finally got BCBS to relent. But wow, it really makes one wonder.

Yeah, that's me, selling catact surgery post-op eyedrops on the black market. Yeah right, I'll make a killing. I mean really, what are they thinking.

 

[cooch96]

Same issues here with DW meds. Gave up on express scripts, but the drug stores aren't much better. Megacorp keeps bragging about the level of care they are providing us, but no real response when I call to complain. And DW reacts poorly to the generics, so we can't even smuggle replacements or emergency dosages from Mexico. Two out f three months, it's a two hour procedure to get her scrip filled. About once every eight months, it turns into a two day ordeal of going to an emergency RN and then coordinating with the pharmacy cause her usual dr can't be found. And that time when her dr moved a couple years ago? That snarled things up so miserably she went two weeks without medication. Miserable.

This is a good rant thread.

 

[scrabbler1]

Some clarification please......

When you say "process a refill" are you saying that the prescription was in place, in Express Script's hands, and simply needed to have the pills counted out and shipped to you? That is, there were still open refills on the original prescription?

Or, are you saying that Express Script would need your doc's authorization to send you additional meds because all refills authorized on the original prescription had been previously executed?

For the original first refill of the second (more recent) drug request, ES claimed they were awaiting authorization from my doctor to switch to them from my local pharmacy. In one of my conversations with ES, I asked them to call my doctor (something they offer to do in their many form letters to me) to get authorization. But when I actually asked someone in their authorization department (a trip through phone menu hell) to make such a call, that rep couldn't DO that and instead transferred me back to their regular customer service rep line where I was on hold for 10 minutes before I gave up.

In the ES website, they said the order was ready to be shipped but they were awaiting authorization. Then, two days later, the order was canceled so when they finally got my doctor's authorization, there were no drugs to actually ship. They had to start over with a new order placed on November 4th. Now, with my doctor's authorization, I am told it will take 8 DAYS for this new order to be processed and shipped. One move left I can try is to call ES again and ask them to speed up the process including shipping time. I had done this on the first order before it got canceled so I may have to try it again on the (re)order.

 

[MRG]

Well go figure. For next year BCBS says I have to use Express Scripts for any drug I regularly take, if I don't after the second refill the price doubles!

Glad I no longer take any meds.

 

[Fermion]

Express Scripts also denies people the quick one pill a day cure for Hep C from Gilead and makes them use a cheaper 6 pill pak which can cause deaths in some cases which already have liver damage.

 

[easysurfer]

Well go figure. For next year BCBS says I have to use Express Scripts for any drug I regularly take, if I don't after the second refill the price doubles!

Glad I no longer take any meds.

Looks like Express Scripts might be better named "Exclude Scripts" .

 

[Gotadimple]

Scrabbler,
Glad to hear you are contacting customer service at your health insurance plan. Discuss the level of service you are receiving. If they are holding back on any meds, let CS know you consider that a very serious situation, and ask, what they can do to resolve it.

then,

Call your state insurance commissioner's office. Tell them what your insurer requires and the details of delays in receiving medications. You are fundamentally filing a complaint. Enough of these, and the insurer will be fined.

Nice to hear that as you go through the annual selection process, you will ask if you can use a retail pharmacy and if not who their mail order company is. You can give them grief about ES - let them know it's the deal breaker on buying their plan.

- Rita

 

[scrabbler1]

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 which dovetails well with what I did yesterday at my local pharmacy to set up this Plan B. We agreed that I should move forward my Plan B tomorrow and get this interim supply so I will have an uninterrupted supply of my drug for the rest of the week until ES sends me the actual shipment which will now be sent out Wednesday with expedited shipping due to arrive at my place a day or two later.


Today's rep also suggested that I ask a supervisor to make a call to my doctor for future authorizations so that snag is avoided. (Then again, if I can switch to a plan which avoids ES that would be better, but I didn't tell her that!) This is still a considerable nuisance just to get a simple refill of a drug.

 

[youbet]

The problem you are having with Express Scripts is somewhat common to all mail order systems. If you want to avoid it, you'll need a non-mail order plan. I think all mail order plans share the issues you ran into.

It's important to note the situation revolves around getting authorization for additional refills from your doc as opposed to filling the original prescription and authorized refills.

Your prescription runs out of refill authorizations. You trigger the pharmacy mail order provider to contact your doctor to authorize additional refills. The pharmacy provider contacts your doc (I don't know how they do this) and the response is delayed or never happens. Your pharmacy provider contacts you to inform you they aren't receiving a response from your doc, for whatever reason. You try to intervene. Etc, etc. That system really is just asking for delay and confusion.

I had a similar situation to yours with another mail order pharmacy provider. In my case, doc wanted to see me before authorizing additional refills of the drug. But getting this info to me now included a third party, the mail order drug provider. It got complicated and resulted in a delay.

Now I totally avoid this by always leaving doc's office with a paper prescription and mailing it in myself. When I run out of refill authorizations, I take the responsibility of contacting doc for a new prescription. Putting a third party in this loop (even if they offer to do it on their web site) is asking for trouble IMHO.

 

[tmm99]

I experienced some glitches, but boy, I was saying so much money doing the 3 month worth of prescription drug mailing that I didn't care.

 

[Winemaker]

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.

 

[jim584672]

I have no experience with ES. When I was at Megacorp we had Mecdco mail order. Total pain in the rear. They made it so you would have to follow a series of steps to get a fill. Almost like they hope you get frustrated and give up.

 

[Alan]

I've used ES for 9 years now agree that it can be a real pain when the refills end, or when changing doctors as we did when we retired and moved State (same Insurance plan).

As mentioned above I always ensure that I leave the doctors office after my annual visit with a paper prescription which I can mail in if needed. (They don't allow a fax unless it is from a doctor's office).

I will say that when it works it works well, but when it doesn't it's diabolical.

 

[growing_older]

My health insurance isn't Express Scripts, but some other mail order pharmacy. I've been paying my $25 copay for two long term prescriptions (90 days supply each). Recently I had to get a 30 day supply at a local pharmacy due to some mixup in the renewal of the prescription. One prescription was $1.50 for a 30 day supply. The other was free. Now I wonder what I've been paying $50 a quarter to the mail order house for.

 

[youbet]

My health insurance isn't Express Scripts, but some other mail order pharmacy. I've been paying my $25 copay for two long term prescriptions (90 days supply each). Recently I had to get a 30 day supply at a local pharmacy due to some mixup in the renewal of the prescription. One prescription was $1.50 for a 30 day supply. The other was free. Now I wonder what I've been paying $50 a quarter to the mail order house for.

When I compare Part D plans annually during the Medicare enrollment period, I'm always amazed at the huge differences in cost for my drug list from one to the other. 2016 will be my 4th year on Medicare and my 4th different Part D provider. It pays to shop!

 

[prudent_one]

I always wondered how my local pharmacy never had issues getting refill authorizations from my doctor, but the mail order pharmacy had trouble about half the time, and I had to get involved.


I decided to go back to the local pharmacy even though it costs a little more. My prescription medication became generic and now it's cheap enough that it only costs a couple dollars more to get it filled locally. Now it's been well over a year and there has never been one glitch. I have never had to get involved with a pharmacy-doctor communication problem.

 

[ERD50]

I had Express Scripts for years. I think it was Medco before that, and now on Prime Mail (and another change next year, it looks like!). Never had a single problem with any of them. One key, I think, is that at least in more recent years, my Doc had a 'direct line' to electronically transfer the info to ES. By the time I got home, I'd usually have an email from ES saying the order was being processed.

Previously, they faxed them in from the Doctor's office, and that seemed to work as well.

In either case, I would just 'click' on-line to order the refill when it was available, and it showed up ~4~5 days later. I need a new 'script from the doc every 6 months, and get one auto-refill on that.

Even the time there was a shortage of one med due to a mfg problem, they sent a one month supply, and automatically sent me the remaining 2 months when production caught up. No hassle for me at all.

The first time I needed a refill was mildly annoying ... Thankfully, I had begun the refill process about 2 weeks before I ran out of pills so I received the refill several days before I needed to take the first one.

To be honest with you, I would not cut it anywhere near that close the first time I ordered a refill from anyone. Things can always get delayed, they might need more info, there might be a temp shortage, or even lost in the mail. I don't even cut it that close now, even though I know I'm set up properly in the system and I've never had a problem. Stuff happens.

Considering the mail might take 3-4 days, and processing could take a couple days, and then there are the non-business days, you really are only allowing less than a week buffer in there. That is too short to correct any problem that might arise. Why not order 4-5 weeks ahead?

-ERD50

 

[youbet]

To be honest with you, I would not cut it anywhere near that close the first time I ordered a refill from anyone. Things can always get delayed, they might need more info, there might be a temp shortage, or even lost in the mail.

Agreed.

And furthermore, you're leaving out the most important item likely to cause delay. The prescription had run out of authorized refills and needed doc to submit an authorization. That's a real "iffy" situation.

I'm sensing in this whole discussion a failure to recognize the difference between ordering an authorized refill and ordering a refill where doc needs to be brought into the loop to provide an authorization.

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.

 

[ERD50]

...

I'm sensing in this whole discussion a failure to recognize the difference between ordering an authorized refill and ordering a refill where doc needs to be brought into the loop to provide an authorization.
...

And I might be missing that as well (though I think I've got it).

In my case, the Doc sends a 'new' 'script every 6 months. It is for a 3 month supply, plus a 3 month refill. Six months later, I have to see the Doc for a 'new' script, rinse repeat. I say 'new', because it is almost always the exacts same 'script as the previous one, so not new meds or new dosage or anything, if that matters.

So it sounds like the OP got caught up in needing the Doc brought in the loop for the refill, which should go smoothly, but adds an 'opportunity for error' and certainly adds a delay.

Although I'm not sure that needing the Doc to authorize a refill would be much different than just getting the new 'script filled? I guess maybe, since the Doc would initiate the new one, and the pharmacy is initiating the request for authorization?

But either way, best to allow more time. Since I've never had a problem, I can't comment on how good/bad their customer service resolution process is.

-ERD50

 

[AllDone]

I loathe ES. My husband was having trouble getting a refill, so I called. The representative told me that "the doctor hasn't called in the refill". I asked if she was sure the doctor hadn't called in the refill and she replied that she was. I said, "Well, that's really strange, because I'm the doctor and I'm quite certain that I have called in that refill twice already this week." They still made me go to the doctor's line and call it in for a third time, but miraculously that worked. This method may not work for everybody, unfortunately.

 

[youbet]

Although I'm not sure that needing the Doc to authorize a refill would be much different than just getting the new 'script filled? I guess maybe, since the Doc would initiate the new one, and the pharmacy is initiating the request for authorization?

Say doc wanted to see you again to check how you're doing on the drug before authorizing an additional six months? He gets a request from the drug provider to authorize additional refills. He tells them no or just doesn't respond hoping that will trigger you to make an appointment and come in. Delay, delay, delay.......

Or doc gets a pile of refill authorization requests from drug providers and his staff needs to pull patient files for review by him for each one? Doing this vs servicing the folks actually coming in for appointments would and should be secondary. Delay, delay, delay......

While I've had my doc sometimes respond promptly to mail order drug house requests for prescription refill authorizations, I've also had him fail to respond or respond "no" without explanation, as forwarded to me by the mail order drug provider. Once he just wanted to see me and do a blood test before continuing me on the prescription. Once his office said they never got the request for the refill authorization while the mail order house claimed they sent it. Blaah, blaah, blaah......

I just go in every six months and get a new prescription. At 68, I've always got something to discuss with him at that frequency. If nothing else, just the subject of how I'm doing with whatever issue the prescription drugs are supposed to be helping with. Medicare + a supplement makes these visits free to me and I don't think seeing my GP twice a year is excessive.

 

[scrabbler1]

I had Express Scripts for years. I think it was Medco before that, and now on Prime Mail (and another change next year, it looks like!). Never had a single problem with any of them. One key, I think, is that at least in more recent years, my Doc had a 'direct line' to electronically transfer the info to ES. By the time I got home, I'd usually have an email from ES saying the order was being processed.

Previously, they faxed them in from the Doctor's office, and that seemed to work as well.

In either case, I would just 'click' on-line to order the refill when it was available, and it showed up ~4~5 days later. I need a new 'script from the doc every 6 months, and get one auto-refill on that.

Even the time there was a shortage of one med due to a mfg problem, they sent a one month supply, and automatically sent me the remaining 2 months when production caught up. No hassle for me at all.



To be honest with you, I would not cut it anywhere near that close the first time I ordered a refill from anyone. Things can always get delayed, they might need more info, there might be a temp shortage, or even lost in the mail. I don't even cut it that close now, even though I know I'm set up properly in the system and I've never had a problem. Stuff happens.

Considering the mail might take 3-4 days, and processing could take a couple days, and then there are the non-business days, you really are only allowing less than a week buffer in there. That is too short to correct any problem that might arise. Why not order 4-5 weeks ahead?

-ERD50

I had an existing 30-day supply, so I can't order a refill before I have received the supply I want to actually refill. In retrospect, 2 weeks was not enough this time but for the previous drug's refill, it was even though I had a similar snag. So, even despite that authorization snag, and now on the lookout for it in case it happened again with the more recent drug, I did not expect things to actually get worse this time. How could I know they would cancel the original order and start a new one which set me back over a week?

 

[Dreamer]

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.