When Mail Order Pharmacies Can’t Deliver!

     “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

5 Comments to “When Mail Order Pharmacies Can’t Deliver!”

  1. By jaden, July 28, 2010 @ 12:41 pm

    Add to this my complaint that as a pharmacist in a hospital, it’s very difficult to obtain a Medication Reconciliation Record in real-time as a registered pharmacist is often forced to jump through hoops created by non-pharmacists. My State Board of Pharmacy does not require pharmacists or pharmacies to register or obtain NPI numbers and the technicians at Caremark and other major-sized mailout order houses (NOT the VA pharmacy) only will speak to pharmacists with NPIs because the ‘Caremark tech cannot tell if the person they’re talking with is a legitimate pharmacist or not’. Oftentimes, these ‘techs’ (if they’re legitimate pharmacy techs) refuse to transfer a pharmacist to speak to another pharmacist with regard to therapeutic issues about the patient e.g. medication history, last filled script, physician ordering, etc. or even if the patient has scripts. I think mailout pharmacies should be made to comply with all state board rules, that their clients are customers.

    The other main issue with mailouts like Caremark are the monopoly they achieve. It is not right that a drug company should tell a patient where they can get their prescription and not be available 24/7 such as some retail pharmacies.

      (Quote)

  2. By Frantic Pharmacist, July 28, 2010 @ 2:24 pm

    I am also unclear on how they get around the ‘counseling’ thing. Supposedly there is someone available 24/7 to answer patients’ questions, but any of us who have called a mail order pharmacy know that’s not quite as easy as it sounds. And, if someone says their inhaler or Epi-Pen isn’t working right, just how do you work with them over the phone? I know sometimes patients don’t get their prescriptions/refill requests in on time (surprise! — we can’t even get them to call a day ahead, much less 5-7 days!!)
    I get lots of people wanting to ask me questions about their medication, then produce a bottle from a mail-order company. I know it’s not totally their fault — the system’s just bad.

      (Quote)

  3. By MAIL GUY, July 30, 2010 @ 10:23 pm

    Wow… some real good points made here..

    Let me get an answer to this “Frantic pharmacist”. How does a retail pharmacist handle a patient calling over the phone saying their Epi-pen isn’t working?

    I will premise this back to you. How many times has a patient come into your pharmacy in the midst of an anaphylactic reaction asking you to explain how to use this device? My guess is that if they chose to drive/ride back to the pharmacy they might succumb first. I am going to guess the answer is 0. I am also going to guess this is the same answer for the asthmatic patient in distress. I would assume however that you have had patients call about usage of medications over the phone and you have answered. Obviously no different than mail order.

    As far as counseling goes….please. I, as a mail order pharmacist, fill plenty of medications at retail for my family (wife 3 young kids) for non-maintenance medications. In my area I have filled at Wag, Krog, Meier etc. My state REQUIRES mandatory counseling on all new prescriptions. You know how many times I have been offered counseling…….ZERO…. Yes a big 0.
    I am sure it is just my neck of the woods with a problem though right?

    You retail guys are full of shiiiiiiit!

      (Quote)

  4. By Wellillbe, August 1, 2010 @ 3:46 pm

    Ive had patients who do not have insurance through the mail order company I work for, call for counseling becuase they “don’t trust their retail pharmacy “or becuase “they are to busy to answer my questions”. Counseling over the phone is incredibly effective in most situations. no other distractions for the pharmacist and no privacy concerns for the patient. They arent standing 2 feet away from their neighbor, they are calling from the privacy of their home. There are benefits and negatives to both retail and mail order. I worked retail for longer than I have worked mail order. I have worked big box pharmacy and Independent, and guess what as far as being treated as a professional mail order wins hands down. As far as my patients expressing their thanks for disucssing their conerns and medications? In all honesty its a tie. But given the choice I will stay with mail order. By the way items that are temperature sensitive are typical mailed overight with appropriate packaging. Its the patients that order their insulin and then leave town and complain the insulin was outside when they get back that tick me off. Common sense is missing from some patients at both locations, mail and retail.

      (Quote)

  5. By att Bubba, December 19, 2010 @ 6:11 pm

    Folks,,,
    You all signed up for this. Complaining now is as useful as when you elected our president. You all thought he was a good thing. Both were an emotional fling with change, now you have change. If you want something different then do something different. I can live without the comfort drugs and pray for the needed meds to be delivered on-time and the correct item, but I don’t have to. My drugs don’t cost me anything. If you can’t adjust to change I suggest you wage war on the folks in Tech-My-Hindu, India. They are who our souls were sold to this week. If you want the America we had 30 years ago I urge you to figure who and how our leaderships sold our position in the world for some trinkets that they and their benefactors will enjoy for generations to come.

    Face it… If the country’s citizens told you to do what you want but just let them not have to be involved,,, wouldn’t you set youself up with a future of wealth? That is where I find no guilt that you have whats left over when I get what I want. If you wanted something else you should have got off your butt and done something many years ago.

    Wow… some real good points made here..Let me get an answer to this “Frantic pharmacist”. How does a retail pharmacist handle a patient calling over the phone saying their Epi-pen isn’t working?I will premise this back to you. How many times has a patient come into your pharmacy in the midst of an anaphylactic reaction asking you to explain how to use this device? My guess is that if they chose to drive/ride back to the pharmacy they might succumb first. I am going to guess the answer is 0. I am also going to guess this is the same answer for the asthmatic patient in distress. I would assume however that you have had patients call about usage of medications over the phone and you have answered. Obviously no different than mail order.As far as counseling goes….please. I, as a mail order pharmacist, fill plenty of medications at retail for my family (wife 3 young kids) for non-maintenance medications. In my area I have filled at Wag, Krog, Meier etc. My state REQUIRES mandatory counseling on all new prescriptions. You know how many times I have been offered counseling…….ZERO…. Yes a big 0.I am sure it is just my neck of the woods with a problem though right?You retail guys are full of shiiiiiiit!  (Quote)

      (Quote)

RSS feed for comments on this post. TrackBack URI

Leave a Reply

*

Click to Insert Smiley

SmileBig SmileGrinLaughFrownBig FrownCryNeutralWinkKissRazzChicCoolAngryReally AngryConfusedQuestionThinkingPainShockYesNoLOLSillyBeautyLashesCuteShyBlushKissedIn LoveDroolGiggleSnickerHeh!SmirkWiltWeepIDKStruggleSide FrownDazedHypnotizedSweatEek!Roll EyesSarcasmDisdainSmugMoney MouthFoot in MouthShut MouthQuietShameBeat UpMeanEvil GrinGrit TeethShoutPissed OffReally PissedMad RazzDrunken RazzSickYawnSleepyDanceClapJumpHandshakeHigh FiveHug LeftHug RightKiss BlowKissingByeGo AwayCall MeOn the PhoneSecretMeetingWavingStopTime OutTalk to the HandLoserLyingDOH!Fingers CrossedWaitingSuspenseTremblePrayWorshipStarvingEatVictoryCurseAlienAngelClownCowboyCyclopsDevilDoctorFemale FighterMale FighterMohawkMusicNerdPartyPirateSkywalkerSnowmanSoldierVampireZombie KillerGhostSkeletonBunnyCatCat 2ChickChickenChicken 2CowCow 2DogDog 2DuckGoatHippoKoalaLionMonkeyMonkey 2MousePandaPigPig 2SheepSheep 2ReindeerSnailTigerTurtleBeerDrinkLiquorCoffeeCakePizzaWatermelonBowlPlateCanFemaleMaleHeartBroken HeartRoseDead RosePeaceYin YangUS FlagMoonStarSunCloudyRainThunderUmbrellaRainbowMusic NoteAirplaneCarIslandAnnouncebrbMailCellPhoneCameraFilmTVClockLampSearchCoinsComputerConsolePresentSoccerCloverPumpkinBombHammerKnifeHandcuffsPillPoopCigarette

Spam Protection by WP-SpamFree

15 visitors online now
5 guests, 8 bots, 2 members
Max visitors today: 22 at 01:11 am EDT
This month: 65 at 08-22-2014 05:19 am EDT
This year: 142 at 03-07-2014 08:46 am EST
All time: 142 at 03-07-2014 08:46 am EST

© 2009-2014 The Redheaded Pharmacist All Rights Reserved -- Copyright notice by Blog Copyright

Log in here! °° Register