“What do you mean my co-pay is $67.00?” A customer asked me that question the other day at the check out counter. They quickly added “I’ve ALWAYS paid $15.00 for this medication in the past!” The word always is a dangerous word for a patient to use at work because if you use the word always you are under the false pretense that things don’t change. That small list of things that you can guarantee someone (death and taxes) should also include a third thing: change.
But back to the story. So now I find myself in a familiar role of “detective” at work where I try and figure out a customer’s health insurance plan for them. As I looked up the patient’s profile I did notice that they had filled this prescription multiple times previously this calender year and sure enough their co-pay was indeed $15.00 each time they had that particular medication filled. So now I look for other clues like is there a deductible they are now having to meet or other issue that might explain the much higher price. No deductible and their plan hadn’t changed so I am now officially stumped.
Just as I start to give up I think to ask the patient “who is your employer?” Now that might seem like a strange question until you realize that several major employers in my area have switched to insurance plans for their employees that force them to use mail order pharmacies. And sure enough, this patient’s employer was on that list. You see, their employer’s health plan stipulated that they can fill a prescription up to three times via a traditional retail pharmacy but after that point the medication is then considered a “maintenance” medication and the patient must use a mail order pharmacy for any further refills. Of course, as is the case in this situation, the patient has the “choice” to continue to use their regular retail pharmacy instead of the mail order option after their three allowed fills but they will do so at a cost. Their insurance plan will charge them a severe penalty for continuing to choose to fill a maintenance medication through a retail pharmacy. And that fact is one of the major problems I have with mail order pharmacies: people are forced into using them.
And why is the forced option of mail order pharmacies bother me so much? Well, if mail order pharmacies were reliable and delivered on their promises then I wouldn’t have a problem with them. The problem is that they don’t often deliver on their promises to patients and then the local retail pharmacies that have always served customers quickly and efficiently are the ones that have to come in and bail out the mail order pharmacies so the patient doesn’t go without an important medication. And that is another problem I have with mail order pharmacies: they don’t deliver on their promises.
Here is what I don’t understand: why can’t mail order pharmacies fix their own problems and mistakes? Here is what really bothers me. An insurance company forces it’s customers to switch to a mail order pharmacy from a traditional drug store. That patient complies with the new rules and uses the mail order pharmacy to fill their prescription. The mail order pharmacy doesn’t fill and deliver their medication in time so guess what happens next? That patient comes through my door with an emergency prescription for a supply of drugs until the shipment that should already be at their front door gets to them. What?
I’m not saying that I mind helping patients out by spending all that time on the phone to get 7 days supply of their medication authorized because their mail order hasn’t arrived yet. I don’t want them to go without their medication for even one day. But it bothers me that the very same insurance company that shut us as retail pharmacies out of the filling process are the ones that then come to us to bail them out when they can’t deliver on their promises. That isn’t right! My theory is that if a mail order pharmacy doesn’t send something in time THEY should fix their own screw-ups! If that means they overnight a shipment to a patient or some other arrangement then so be it!
And one might try to give me the argument that “the patient chose their prescription insurance plan” and that they should have known that plan included a mandatory mail order pharmacy option. I just don’t buy that argument because patients really don’t have a choice on their own. Under the current healthcare system in the United States health insurance is usually coupled to employment. This means that while a customer has the ability to choose which health plan they receive they are limited to the choices offered by their employer. If all of their health insurance plan choices have a mail order pharmacy clause then they are stuck choosing that option.
And since I am on a role this morning complaining about what I don’t like about mail order pharmacies I will add another item that bothers me here. It really bothers me that they seemingly operate under their own set of rules. If I live and work in a state that requires counseling on every prescription then every mail order pharmacy filled prescription should have counseling too! If the bottles that are dispenses at my pharmacy have to include 15 different pieces of correct information including the pharmacist’s name that fills the prescription then the mail order pharmacies should operate under the same set of rules. It just seems to me that they should play by the same set of rules that everyone else must live by.
I also worry about the integrity of refrigerated products that are delivered to patients through mail order pharmacies. We are experiencing a severe heat wave in my part of the country right now and I can’t imagine having a refrigerated prescription product sitting in a box for several hours outside. Those drugs just can’t handle extreme temperatures like that for an extended period of time. How safe is that for the patients?
I believe in patient choice. I think that patients should have the ability to opt out of being forced into using mail order pharmacies. And anyone that says “technically they aren’t being forced into using the mail order pharmacy” should look at the price difference being charged to the patient for their medication. That big price difference is making the choice for them. Mail order pharmacies have their place in pharmacy but no patient should be forced into using them because of extreme financial incentives. But that isn’t how our system works now. And there is no real recourse for a patient that gets stuck with a mail order pharmacy that can’t deliver. And when it happens often the very retail pharmacies that are shut out of filling maintenance drugs by the health insurance plans are the ones left to fix the problems created by mail order pharmacies that can’t deliver on their promises. And that to me is wrong. What do you think?
The Redheaded Pharmacist