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
