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Sunday, March 01, 2015

WHEN DID THIS BECOME HEALTH CARE?

February 28, 2015

 Daniel J. Loepp

President and Chief Executive Officer
Blue Cross Blue Shield of Michigan
MPSERS — Mail Code X521
Blue Cross Blue Shield of Michigan
600 E. Lafayette Blvd.
Detroit, MI 48226-2998

Dear Mr. Loepp:

I am writing to express my frustration with Blue Cross Blue Shield PPO’s practice of contracting a different mail order pharmacy annually. BCBS PPO is my medical insurer as part of the Michigan Public School Employees Retirement System.


On December 18th I spent over an hour online, on the phone, and in the drugstore trying to get a prescription for Bystolic 10 mg. refilled. Bystolic is a medication that I have taken for over a year for high blood pressure. The mail order service, Express Script, contracted by BCBS PPO lost my prescription. First they told me that they couldn't authorize a duplicate order because they had to wait 30 days to make sure it was really lost. Although I had ordered a refill in plenty of time, at this point I had no pills left and they said they would expedite a duplicate order. I let the customer service representative know that my doctor had called in a prescription at my local pharmacy to tide me over for the next 2 weeks. When I arrived at the pharmacist’s, he couldn't fill it because my mail order pharmacy wouldn't authorize payment, claiming I had filled it at a Walmart in Arkansas. I have never been to Arkansas nor do I shop at Walmart. My name is not a common name and when the pharmacist called the Arkansas Walmart, they had no patient with my name. Having reached an impasse with the mail order pharmacy, my local pharmacist gave me enough pills to make it through the next day and a half until I could call Express Script so my pharmacist could be reimbursed for the prescription to tide me over until Express Script sorted out the problem.


On December 19th, I spent another 2 hours trying to resolve this issue. I called the automated line for Express Script. The automated service routed me to the wrong department and issued the recorded message "Due to unusual caller volume, your wait may be longer than anticipated. Please consider using the contact portal on our website..." I re-tried and was connected with a customer service employee to whom I told the story of my lost mail-order prescription and asked to have permission for my local pharmacy to be paid for pills to tide me over. She said, "I'm very sorry but your prescription was already paid for on December 12th." Since it was clear that this employee was neither informed nor empowered to solve my problem, I asked to be connected to the supervisor who could not authorize my local pharmacy, because she only worked with mail order operations. She called another company to get authorization. Not wanting to leave anything to chance, I got a phone number for this other company, and called my pharmacy to verify that the prescription was authorized and ready for pick up. Believing that this was an anomaly, I put this experience behind me.

On December 30, 2014, I was notified by email that the mail order prescription service would be changed to Catamaran Rx in January 2015. I had difficulty using the link in the email to register a user name and password on their website and later used their contact portal to notify them of the problem. I received no response. 


At the end of January or early in February, I tried to order a refill of Bystolic 10 mg., but when I finally got online to order it, I discovered that my prescriptions had not transferred over from Express Script. By then, I was getting dangerously low on this medication, and asked my doctor to call in a two week prescription at my local pharmacy to tide me over, and to send a complete list of my prescriptions to Catamaran Rx so I could order refills when I was running low on them. I picked up the “tide-over” prescription and on February 16th called Catamaran to send the 90-day refill as soon as possible. They claimed that they couldn’t send it until February 27th because it was too soon. They asked me to get a 30-day prescription at my local pharmacy and said that then they'd send my medication out. Of course, this begged the question: if they had to wait until I was out of medication to send my refill, wouldn’t I need to get another prescription from my local pharmacy to tide me over...triggering another delay in the mail order? None of the customer service representatives seemed to be able to understand that they were not solving, but rather creating, a snowballing problem. 

It is now February 28th, and I have one weeks’ worth of Bystolic 10 mg. left. Today, I received a robo-call from Catamaran Rx telling me that they were about to ship a prescription but that it exceeded cost. I got connected with a customer service person who explained that the medication was in the formulary but was considered part of “step-therapy”—I would have to have taken another medication and have it be ineffective in order to take Bystolic! There were only two solutions to the problem: my doctor could call the mail order clinical services to get the name(s) of some substitutes for Bystolic, or he could “initiate a prior authorization for Bystolic” but some penalties for cost might apply. At that point she said that I had been notified by letter that there were some policy changes that Catamaran had implemented.  I asked her to re-send the letter by both postal mail and e-mail since I had not received such a letter.


I took down all of this information, acknowledged that the customer service person was neither empowered to override this problem, nor did she have any expertise to inform me of acceptable generic substitutes for Bystolic and that, since it was a Saturday, the only thing I could do was wait until Monday to speak with a knowledgeable and empowered pharmacist who could provide me with enough information to refill my prescription by the time I again ran out (on March 7th). Of course, I pointed out to her, this would probably necessitate another temporary “tide over” refill at my local pharmacy which is frowned upon by BCBS PPO and its’ contractor Catamaran Rx. I expressed my disappointment in Catamaran for having more concern for its bottom line and for a rigid adherence to irrational rules that prevent the timely refilling of established prescriptions, and informed her that my only recourse was to send letters of complaint, in the hope that BCBS, MPSERS, and Catamaran would re-think this kind of business plan, that operates without regard for the welfare of its customers.

I don’t imagine that I am alone in this complaint, but I have no way of verifying that others have also experienced such disregard. I can only hope that someone who receives this letter is able to gather such data and encourage a more responsive approach to health care service.

Sincerely,


N. Kathleen Kosobud


Copies mailed to:

State Representative Jeff Irwin
Michigan House of Representatives
S-987 House Office Building
P.O. Box 30014
Lansing, MI 48909-7514

Senator Rebekah Warren
Michigan Senate
PO BOX 30036
Lansing, MI 48909

Phil Stoddard, Executive Secretary
MPSERS Board of Directors
Office of Retirement Services
PO Box 30171
Lansing, MI 48909-7671

Judy Foster, President
MEA-Retired
1216 Kendale Blvd
East Lansing, MI, 48826-2573

Joel Saban
Executive Vice President, Pharmacy Operations
Catamaran Rx
1600 McConnor Parkway

Schaumburg, IL 60173-6801

1 comment:

Kathleen Kosobud said...

Post-script: Got a call from Catamaran--cost containment doesn't seem to be their concern so much as their concern that I will pay for the medication. They didn't have my credit card number on file. Once I gave them a credit card number, they were perfectly happy to fill the prescription. So, I conclude that all of the other stuff was smoke and mirrors. No concern for my health, my financial security, or my safety--just making sure I wasn't going to scam them out of the cost of blood pressure medication. KK