<p>Our insurance plan uses a mail order pharmacy. D takes a drug prescribed by her doc at school, who wrote out a 90 day Rx (as we’re continually getting pushed to do by the insurance company) to cover her over break and until her next appointment. I mailed it in. The Mail Order pharmacy just called. They want to fill it with the brand rather than the requested generic on the basis that the brand is cheaper. Nice, but with this particular drug D takes a different dosage in the brand vs. the generic, so it isn’t a straightforward substitution. (I know generics are supposed to be therapeutically equivalent, but this one wasn’t. We’ve tried before.) I declined. Then they tell me that they can’t fill it with the generic because they don’t have the generic in stock. OK, fine – mail the Rx back. Which they say will take 14 days, maybe longer with the holidays. Their suggestion was that D should just go back to the doc (who is in a different state and on winter break just like she is) and instead get a new scrip. Aargh. Three supervisors later and I finally have grudging agreement to get the Rx scrip expedited back to us, but it took requesting the pharmacist’s license number and state of licensure and the threat of filing a complaint with the State Board of Pharmacy before we got to that agreement.</p>
<p>Given that it requires a special override code every time we’ve filled the generic at the local pharmacy I am increasingly of the theory that the Mail Order Pharmacy is getting rebates (kickbacks) from the brand name maker in return for not stocking the generic, and for putting the generic in a more expensive tier than the brand name version. I’m hacked.</p>
<p>The whole mail order pharmacy thing is making me CRAZY!</p>
<p>I don’t want to have all the hassle of mail order … for many of the reasons in your post. Not to mention that my doc changes my prescriptions fairly often … so I don’t want to have a 90 day supply.</p>
<p>I love mail order. Of course, I haven’t had a problem with it. Our policy clearly states that the prescription will be filled with the LEAST expensive option UNLESS the doctor writes “Dispense as Written” on the script itself. You might want to try that next time.</p>
<p>Thumper – we did . The doc specified generic. I added a note to the Rx amplifying that the patient required the generic – and the mail order pharmacist told me that my writing anything on the prescription could invalidate it!</p>
<p>Our mail order only works two ways: either it’s quick and easy or it’s an absolute nightmare. Based on several years’ experience, I’d say 20% nightmare, and like arabrab says, it takes forever to get the script back. Usually it has taken me ~ 2 months. That’s if I even know there is a problem. They usually leave cryptic automated messages “call us! call us!” and they don’t leave a call back number. Nice. I love the fact that if they have a question, they will NOT call the dr. Nope, just reject the script.</p>
<p>Gotta hate Anthem. Even worse, by FAR, are their flexible spending accounts. They audit about 35% of transactions, requesting tons of documentation, about 6-8 months after the date of service. Not weird stuff either–just basics like hospital charges and dr. visits. They are definitely trying to make it so horrible no one will opt for FSA.</p>
<p>OP-no answers or suggestions, but lots of empathy. Good luck!</p>
<p>I’d complain to your medical insurer. What the mail order pharmacy is doing needs to be brought to their attention so they can decide how they want to handle it. If enough grumble, they will take action and/or switch mail order companies.</p>
<p>Might also complain to your insurance commissioner & board of pharmacy. Really sounds like a racket to me!</p>
<p>When we 1st started using the mail order pharmacy, I was very upset because they’d deliver & leave the meds in the hot sun on our doorstep with no one home. I have since switched deliver address so it goes to an A/C office where someone is there and will make sure I get it. Since then, I’ve been fairly content with the series of mail order pharmacies our insurer has contracted with–we have a STRONG monetary incentive to use the Mail Order pharmacy contracted so we generally do.</p>
<p>This is true. YOU cannot write anything on the prescription that relates to the dispensing of the drug itself.</p>
<p>BUT if your doctor writes “Dispense as Written”…it should be dispensed as written unless your policy specifically doesn’t allow for this. So check your policy AND check with th insurer.</p>
<p>Also, in our experience…if our mailorder will not dispense something and have our insurance cover it, neither will any pharmacy we go to. </p>
<p>One thing you really should check is the provisions for generic drug coverage. MANY policies now actually require dispensing of generics if they are made for your drug (unless the doctor notes otherwise…sometimes it’s a song and dance). If your policy has this provision, you are in good standing to get that mail order outfit to fill with the generic.</p>
<p>I’m not sure it’s the mail order…it’s an issue with prescription medication in general. I find it annoying that some “gate keeper” is the one who approves your scripts, regardless of what the doctor who treats you says…but that is another thread.</p>
<p>Manufacturers compete to have contracts with pharmacies for them to carry their specific drugs. With retail, you only see this with the generics. With mail order, brands can get involved. The manufacturers will give discounts/rebates to the pharmacy/hospital if they carry their brand as preferred.
In mail order, a brand can be their preferred product. It can be the cheapest one available. By law, you cannot substitute for a generic, if the brand is cheaper.
The PBM might get rebates if they have the brand is preferred. There are a few policies in which the PBM will only cover brand.</p>
<p>I’ve never had to deal with mail-order pharmacies but it sounds like this is a general pharmacy issue and that it could happen at a retail pharmacy as well as a mail-order pharmacy. I think we would look at buying the medication outside of our plan if we ran into a similar problem.</p>
<p>“… just basics like hospital charges and dr. visits.”</p>
<p>… and dental fillings. Weird, because the claim clearly states “filling.” I end up sending in a copy of the bill Anthem has already received. I mean what other “documentation” could be provided? An affidavit from the dentist???</p>
<p>Would not go so far as to want ANY drug available for whomever has the $ to buy it without a md or other healthcare professional’s oversight. </p>
<p>That said, I feel there are a significant # of meds that really don’t need all that much oversight & it’s more a $$$ thing–why & how did Prilosec, Claritin & Zyrtec suddenly get “safe enough” to be available OTC when before it needed a Rx? It’s more about patents expiring and generics competing & threatening market share. I still remember the days when motrin was Rx only as well and considered STRONG medication.</p>
<p>There definitely are problems with the way things are currently being done, as is evidenced by the $3 billion in Medicare fraud regularly attributed to Miami, to go with the $60-90 billion in US Medicare fraud annually. Sorry for the rant and getting sidetracked but it is upsetting!</p>
<p>While it is true that any writing on the actual presecription would invalidate it, if the Dr. requests DAR, then no substitution is allowed without the Dr.'s consent. I find it odd that the generic is a different dosage, especially since there is a strong likelihood that multiple companies make the generic, unless the brand has been reformulated from the original formula. If it happens again, then it is a great idea to report this to the regulators. In fact, the pharmacist should not have contacted you but rather the Dr first.</p>
<p>sorghum- pharmacists are the people that make sure that your drugs don’t interact. A doctor gets only a small amount of pharmacology, whereas the pharmacist gets 6-8 classes and is responsible to check those interactions. I would not want to die of a drug interaction - especially if it was based on my own stupidity.</p>
<p>The problem for a good many of us is that for our chronic conditions, we are “encouraged” to use the mail order pharmacy while for our more immediate accute conditions, we are “encouraged” by our medical insurers to use the local pharmacies. They often don’t have the same list of all the meds we’re taking & therefore have difficulty warning us of interactions. The mail order folks rarely have ANY interaction with patients and mainly do billing & be sure the correct med is mailed to the correct address (or that’s the impression I’ve gained over the past 10 years from the patient’s perspective). The local pharmacists are often timed as to how long/short they spend with the patients and how quickly they can get everything done. These constraints make patient-centered counseling very challenging from everyone’s perspective.</p>
<p>But if something goes wrong, there licenses are still pulled and they are still sued. Even with mail order, they still at least run a program that looks for interactions. The biggest problem is that we Americans juggle multiple doctors, multiple pharmacies and OTC drugs that are not known to a pharmacist. I feel very sorry for the pharmacists that I know, since they are generally managed by idiots that know nothing of the profession and don’t care about the patients.</p>
<p>In the old days, I believe that we would go to the pharmacy and get the drug prescribed but would pay a smaller co-pay if we chose a generic. Today the generic might be the default. We don’t get enough prescriptions on a regular basis to know but the last time I had a prescription filled, it was for a generic.</p>
<p>If I had asked for the name brand drug, I wonder if they would have charged me the difference between the generic and the name brand.</p>
<p>BTW, I’ve read local stories where pharmacies have mixed up prescriptions with pretty bad results. I understand that this sometimes happens with mail-order pharmacies too. Mail-order also has the problem of postal theft.</p>
<p>I had a friend that told me about drug stores in the Philippines. You just go in and buy what you need, very cheap. No prescriptions needed. I don’t know if that is for the country or just for his local area.</p>
<p>In Mexico, you also don’t need Rx for most meds, you just go to the store & buy what you think you need & take it, including antibiotics and many other meds.</p>
<p>It is tough for pharmacists with multiple pharmacies and multiple docs. Even as a patient, I sometimes have a tough time remembering when I was last prescribed an antibiotic and when I actually TOOK it (sometimes my docs prescribe them for me to travel with & I don’t ever take them UNLESS I have an infection while traveling & let the doc know via e-mail what’s going on).</p>
<p>It is very difficult for anyone to keep track of EVERYTHING unless they are in a HMO-type setting where there is a combined electronic medical record that keeps track of ALL the docs & ALL the meds & conditions for the patient. It is one of the risks/benefits of the current private system that allows us to choose our docs, some of whom have conflicting medical records systems. Our BC/BS insurer is working toward having all docs use electronic medical records but they aren’t all compatible–insurer is working on that as well, reimbursing more for those who use the PREFERRED system.</p>
<p>Regarding the actual scrip that was sent in and going to be returned, either slowly or quickly- could a patient call the doctor’s office on this and have them fax a duplicate request to the local pharmacy? Unless it was a controlled pain killer, I cannot see the doctor having a suspicion you are trying to double dip!</p>
<p>It is a big hassle when they have possession of the scrip and you suddenly need to get it at a local pharmacy. That said, my daughter takes an expensive drug that is not available in store pharmacies at all because it’s too expensive and too perishable to keep in stock. All we have to do is call in once a month (after a nice reminder call) and they ship it to her door packed in ice (has to stay cold) along with whatever else she needs for the process of self-injection. Even if it was available in stores, it’s less work to call than to drive to a store, let alone go in and wait in line. My husband is on multiple medications and does most of them by mail-order. But if something is critical should he lose it, the scrip is at the local pharmacy. That way he can replace it immediately with less hassle.</p>