Sunday, December 4, 2011

Where Is The Choice And Competition In Filling Prescriptons?

Do you like being forced to use only a mail-order pharmacy? Do you miss being able to have an actual conversation with your pharmacist, who knows your history and is happy to take a few minutes to answer some questions about how to take your medication? For me, the answers are 'Definitely not' and 'Absolutely'!

We are insured through my husband's employer(their parent company, to be accurate) and pay what amounts to a rather substantial co-payment of premiums for top-of-the-line PPO insurance. On that portion of our health care, we have pretty good choice and competition.

However, when it comes to our prescription plan, we have one option: Express Scripts. The only way we would be allowed to continue to receive coverage for our prescriptions and choose our local pharmacy would be to choose a Kaiser plan for our Health Insurance. Outrageous! Why should we have to do that? Why should our medical care have to suffer if we want to improve our prescription care?

Where's the so-called choice and competition for prescriptions? There is none. Once again the "Big Boys" are driving all their competition out of business, forcing us to use only their company or pay hundreds — or even thousands — of dollars out of pocket for needed medications our doctors have put us on.

This has to change.

Last week I had yet another in an ongoing series of problems with Express Scripts. After making four attempts using their website to request a new prescription for one of my medications, and each time getting a nondescript "Unable to process your request at this time" error message, I used the site's contact form to notify customer service and ask them to resolve the problem. More than a full day later I received a reply by email. It advised me to use their website to request a new prescription.

Yes, really.

In a fit of fury I shot off a reply, cc'ing the company's CEO, George Paz*, berating them for not bothering to actually help me, let alone acknowledge the specific problem I had encountered, and letting them know that I would be filing a complaint with Viacom, through whom we get our insurance.

First thing Monday morning a representative from the corporate office called me, apologizing for how I had been treated by their customer service. The CEO had, in fact, received my email and was none-too-happy about its contents. That particular customer service department will be receiving new training, tech support will be updating its error messages to be more specific and helpful to the customer, and my doctor had already been called and had renewed my prescription. That, along with two other prescriptions were sent out that morning via UPS next day delivery at no additional charge to me.

But it should never have had to come to that.

I'm probably one of the lucky ones, in that I'm not afraid to stand my ground and fight for what I know I have a right to expect as a paying customer. Others, not so much (my husband among them; when I told him the outcome he said, "You're going to have to teach me how to do that."). According to Healthcare Finance News, in an article titled, Survey: Widespread problems with mail order pharmacies, "Many patients go without their prescribed medicine due to the slow or ineffective service of mail order pharmacies."

Can you imagine?

The article goes on to say, "The survey of more than 400 patients found 48 percent of respondents who were mail-order customers had to go without their medications because of late delivery. Those patients who are required by their health plan to use mail order reported higher rates of late delivery (63 percent) than those who had a choice of pharmacy (28 percent)."

Think about that. Nearly two-thirds of patients who are forced to use a mail order pharmacy receive their medications late.

And yet year after year, new enrollment cycle after new enrollment cycle, Americans are given zero choice as to how their prescription medication will be filled or delivered. None.

Do you think it's bad now? It's about to get a whole lot worse.
In July, Pharmacy Benefit Manager (PBMs) giants Express Scripts and Medco announced they would merge. This transaction is currently ... pending approval by the Federal Trade Commission (FTC). If approved, this merger would lead to reduced consumer choices in pharmacy, higher premiums for plan sponsors and consumers and reduced access to community pharmacies for plan beneficiaries.
But all hope is not lost.

There is legislation pending in both the House and the Senate that would eliminate this problem once and for all.

On the House side it is H.R. 1971, introduced by Representative Cathy McMorris-Rogers (R-WA), titled Pharmacy Competition and Consumer Choice Act of 2011. Its purpose is "to amend the Public Health Service Act to ensure transparency and proper operation of pharmacy benefit managers."
Pharmacy Competition and Consumer Choice Act of 2011 - Amends the Public Health Service Act, the Employee Retirements Income Security Act of 1974 (ERISA), the Internal Revenue Code, and part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to prohibit a group or individual health plan from entering into a contract with any pharmacy benefits manager (PBM) to manage the prescription drug coverage provided under such plan or to control the costs of such coverage unless the PBM satisfies the requirements of this Act. ...
On September 8th it was referred to the Subcommittee on Health, Employment, Labor, and Pensions, where it still sits as the year is quickly running out.

On the Senate side is S. 1058, also called the Pharmacy Competition and Consumer Choice Act of 2011, introduced by Senators Mark Pryor (D-AR) and Jerry Moran (R-KS). It, too, is sitting in committee.

So I urge each and every one of you to

And ask them, "Where is my 'Choice & Competition' regarding my prescription needs?" Tell them your pharmacist can be just as important as the doctor you choose and ask for their support for the Pharmacy Competition and Consumer Choice Act.

*For the record, here is how George Paz's compensation stacks up with his "competitors" in the field (does anyone else see anything wrong with this picture?):

George Paz Chairman, Chief Executive Officer and President, Express Scripts Inc. $10.3M
Gregory D. Wasson Chief Executive Officer, President and Director Walgreen Co. $1.2M
Angela F. Braly Chairman, Chief Executive Officer, President and Chairman of Executive Committee WellPoint Inc. $1.1M
David M. Cordani Chief Executive Officer, President, Director and Member of Executive Committee Cigna Corp. $1.0M
Mark T. Bertolini Chairman, Chief Executive Officer, President, Chairman of Executive Committee and Member of Investment & Finance Committee Aetna Inc. $937.3K
Steven H. Collis Chief Executive Officer, President, Director and Chairman of Executive & Finance Committee AmerisourceBergen Corporation $652.0K


Pharmacy Competition and Consumer Choice Act of 2011 ~ at
Survey: Widespread problems with mail order pharmacies ~ By Richard Pizzi, Editorial Director at Healthcare Finance News
George Paz Executive Profile ~ at Bloomberg Businessweek
Hoey: FTC Should Block the Express Scripts-Medco Merger to Promote Pharmacy Choice, Competition ~ By By B. Douglas Hoey at Roll Call
At Capitol Hill Rally, Community Pharmacists Announce Support for Bipartisan Senate Bill to Bolster Consumer Choice and Pharmacy Competition ~ at National Community Pharmacists Association
Moran Sponsors Bill to Promote Patient Choice and Competition Among Pharmacies ~ at

"How wonderful it is that nobody need wait a single moment before starting to improve the world." ~ Anne Frank

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