Medco Rant

[cabinetman]

You would think that a doctors prescription would be filled by the pharmacy. Not that simple. It seems there is a 'pre-authorization' required. It's like the pharmacy wants to determine that there aren't other drugs to be tried first (or cheaper) before the one prescribed will be filled.

I'm going through that right now, and between the doctors office, their automated ordering service, the insurance company and Medco, it's been going back and forth for over 3 weeks.

Good thing it's not an anti-hallucinogen that I'm out of and waiting for.

Rant over.

[LCHIEN]

You would think that a doctors prescription would be filled by the pharmacy. Not that simple. It seems there is a 'pre-authorization' required. It's like the pharmacy wants to determine that there aren't other drugs to be tried first (or cheaper) before the one prescribed will be filled.

I'm going through that right now, and between the doctors office, their automated ordering service, the insurance company and Medco, it's been going back and forth for over 3 weeks.

Good thing it's not an anti-hallucinogen that I'm out of and waiting for.

Rant over.

Me, too, only its Tel-Drug (Cigna prescription service). TelDrug wants me to try generic similar function medicines, not generic equivalents (there is no current generic equiv). Doc says it's been working for 6 years, doesn't want to risk making changes. I'm caught in the middle now for 4 weeks (doc gave me some from his sample stock). To complicate things, I'm changing insurance companies Sept 1. It's not going to be resolved before then. Sigh.
Is this a taste of socialized medicine?

[Daryl]

Good thing it's not an anti-hallucinogen that I'm out of and waiting for.

Now I get to use this picture.
ps. I am not making fun of your prediciment.

[Uncle Cracker]

I have had the Medco problems with my current insurance provider. It seems Medco, not the insurer, decides which "tier" of co-pay there is on each drug, and whether there will be a requirement to use a cheaper, not identical, medical alternative. They're the same kind folks who put a $30 co-pay on the $31.80 box of needle points that I must use on my insulin pen. I get a benefit of $1.80 (that's 60 cents a month, as the box lasts for three months), and pay a monthly premium of $1050.00...

[JR]

Is this a taste of socialized medicine?

Nope.

JR

[Mr__Bill]

Is this a taste of socialized medicine?

Nope, this is greedy business people making health care decisions for you, a prime example of why health care insurance needs to be overhauled.


Bill,

[herb fellows]

About 8-10 years ago, Medco was the best out there, IMHO. My company switched to Caremark, which was an unmitigated disaster. They finally went back to Medco, and apparently in the interim they have slid downhill considerably.
Ya can't win!

[BigguyZ]

Nope, this is greedy business people making health care decisions for you, a prime example of why health care insurance needs to be overhauled.


Bill,

I don't think you can say that unless you know the specifics. There are a lot of Prior Authorization programs that are created to drive down costs for both the plan and the comsumer. And many times, the plan is not the insurance company, but the emlpoyer. Again, I can't speak for this situation, but oftentimes there are alternatives that provide clinically equivalent outcomes at a lower cost. Dr's don't necessarily know the most about drugs, and do not always take the time to look at what alternatives there are out there. That's what pharmacists and pharmacy managers do.

OK, that's my $0.02.

[Richard in Smithville]

It's not just you guys...it's international. My insurance wanted me to buy a membershop from Costco( 55 dollars per year) and drive a 50 mile round trip so they could save five dollars on filling persciptions.

[Jim Frye]

Insurance prescriptions...

The next time your insurance fills a script for you by mail, check out the name of the drug company that supplied it. It should be on the label. Our insurance pharmacy, NextRx, is sourcing some stuff from India. And the last administration was warning us that we could not buy our drugs from other countries because they could not trust the quality of the medication. Yes, the US health care system does need an overhaul and a ton of oversight. /end rant/

[parnelli]

Long boring info ahead:

Medco/Caremark/Express Scripts are all pharmacy benefit managers(PBM). In essence someone like United or BlueCross or whomever pays them to deal with the prescription side of things so they don't have to. So the formulary (which meds are preferred or non-preferred) is decided amongst really all three mentioned- your employer, the insurance company and also the PBM.

They can decide how much different levels of drugs cost; 10/20 30/60 etc, and they can decide if you must get prior authorization, or try alternates for certain medicines or if certain things are blocked completely.

As for Dr's not knowing the most about drugs- yes and no I suppose. Keep in mind the sheer number of drugs a general practice doc must remember and all the details, dosing, side effects, etc etc. You'd be surprised at how much they remember! But that said, no- they can't remember everything and certainly which drug is on which formulary and which formulary you might have are pretty close to the top of the list!

As for the pharmacist- years ago I'd readily agree that they had your best interest in mind and nothing else- but lets be honest- everything is a business. The pharmacist does sometimes get a bonus for getting people to switch to generics (higher profit margin) and they typically are ranked by generic usage by corporate- a little peer pressure. While cost is important- it's rarely the only important factor to consider.

And yes- many of the generics come from India from companies like Dr. Reddy's etc. Even at $4, WalMart's making money on those prescriptions.

[jackellis]

Someone somewhere recently published a study that found some of the brand name drugs that were advertised on TV were no more effective than older drugs used for the same purpose. I wish I had a link because I'd like to read the story instead of just writing heresay.

I would be fine with drugs from India. Not from China (at least not yet) and not from most of the rest of the developed world, but so far India has been pretty careful to defend its reputation against shoddy business practices.

When its my turn to lean on the system, I fully expect either the doctor or the pharmacist to provide me with the most cost-effective medications, not the most expensive ones.

Good thing I can tolerate aspirin. I'd hate to spring for Tylenol or one of those other fancy pain relievers

[Ed62]

It's not just you guys...it's international. My insurance wanted me to buy a membershop from Costco( 55 dollars per year) and drive a 50 mile round trip so they could save five dollars on filling persciptions.

It seems like it would be to their advantage to pay the membership cost for you. We use Costco, almost exclusively for meds. Where Walgreens might want $175.00 to fill a prescription, Costco might want less than $20.00 for the same thing. I know that seems like it's too good to be true, but my wife has had a prescription or two where that was actually the case. That's not always the case, but Costco has usually been much more affordable, and they are always cheaper. Don't get me started on Walgreens because I might not know when to shut up.

Ed

[Uncle Cracker]

I might not know when to shut up.

Welcome to the brotherhood...

[MilDoc]

Medco/Caremark/Express Scripts are all pharmacy benefit managers(PBM).

Yep. Just another layer making a profit from "health care." Yet folks worry about "single payer" "socialized" (scare word there) medicine?

As for Dr's not knowing the most about drugs- yes and no I suppose.

Oh come on. Not THAT hard, although I would admit most "docs" get their info on the "latest & greatest" from drug reps. Rather than from great sources like the "Pharmacy Letter," etc.

And yes- many of the generics come from India from companies like Dr. Reddy's etc. Even at $4, WalMart's making money on those prescriptions.

And have those generics been tested? probably not.