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Tuesday, November 01, 2005

Held Hostage by Mail-Order Drug Suppliers

My husband and I are fed up with the requirement by GHI, through which we have health insurance, that "maintenance" prescription medications—any medications taken on a regular basis—be filled by mail order through Express Scripts. We're likely not the only ones who can't take it anymore.

Ed (my husband) and our middle child have attention-deficit/hyperactivity disorder (AD/HD), and they both take two forms of methylphenidate for it. Several times, Express Scripts has delayed filling their prescriptions for the drug beyond a reasonable amount of time. Last March and currently, Express Scripts claims to have lost or never received the prescriptions for this drug. For both times, we have proof from UPS that someone at Express Scripts signed for the next-day air or second-day air packages containing the prescriptions; we also have photocopies of the allegedly lost prescriptions. Last March, it was our son's prescription; now, it's Ed's prescription.

Because the drug, which works quite well for both of them, is a class II controlled substance, we can't just have our health care provider call in a new prescription to Express Scripts. She has to write a new prescription, which we have to then ship to Express Scripts; we use UPS because we don't like sending prescriptions through the U.S. mail.


Last March, our son went without medication for a while because of Express Scripts' mismanagement; this affected his academic performance and his relationship with us and with children his age. This time around, it looks as if Ed will miss a few days of medication because of this latest snafu, which means that he will have great difficulty focusing at work and at home, when parenting; at home, this affects his relationship with our children and his relationship with me. For a look at what life is like for our family when the three members with AD/HD are not treated, see this.

When I spoke with an Express Scripts customer service representative on the phone today, he first told me that Ed's prescription had been put aside because it was too early to fill it, because Ed's current bottle of medication runs out on November 7. Later in the conversation, the representative said that there was no record that Express Scripts ever received the prescription. Which version is the truth?

It is ridiculous that Express Scripts is our only option for filling maintenance-drug prescriptions, especially when its staff is apparently incompetent ... or worse. Who knows? Maybe they're filling the prescriptions themselves and selling the medication on the black market.

And what are the frail or elderly to do? Do they have the stamina to spend hours on the phone with Express Scripts fighting just to get their life-prolonging medications on time? Why are we all forced to go this route? It's likely that lobbyists bought the right to abuse customers through mail-order services from legislators with open pockets. Why else have legislators not created and passed legislation that would require health-care plans to allow subscribers to fill prescriptions, maintenance or not, at a local pharmacy if they wish? If we could fill our prescriptions at a pharmacy, we could watch a human being handle our prescriptions to see that they are not lost or misappropriated.


Updated 12:20 p.m., November 2, 2005: I sent this post, in modified form, to the editors of Newsday and Newsweek and to a New York Times reporter, with a carbon copy to Express Scripts. I've also sent it to New York State Attorney General Eliot Spitzer, a bulldog of a public servant who took Express Scripts to court in 2004, accusing the company of fraud.

1:30 p.m. update:

Express Scripts owes my county $845,000.00 "for failing to pass along discounts on drugs required in [its] contract [as the county's drug benefits administrator], according to a new county audit," reported Newsday on October 28, 2005:

Currently under investigation in 19 states for improperly keeping rebates and discounts, Express Scripts could face a legal challenge if county officials decide to join a state lawsuit against the company.

The audit by PricewaterhouseCoopers prompted a strategy meeting Monday by top county fiscal and union officials on how to recover the money.

"We have solid numbers which put Suffolk County in a very strong position to sue or negotiate with ESI [Express Scripts, Inc.]," said Comptroller Joseph Sawicki.

Express Scripts had promised to offer the county savings on prescriptions for employees.

Auditors say the county contract required a savings of 50 percent on each claim. However, the firm maintained that the promised savings were achieved if all claims were taken together. St. Louis-based Express Scripts maintained the county owed them $160,000.

But auditors, who originally found the county was owed $955,000, lowered their finding to $845,000 based on company explanations of other costs.

County officials also say Express Scripts made an informal settlement offer to repay the county, if Suffolk agreed not to join the state suit.

Rita Holmes-Bobo, an Express Scripts spokeswoman, declined to comment.

County Executive Steve Levy said County Attorney Christine Malafi has had direct talks with Express Scripts about the audit and other issues, but he said it is "premature" to talk about a settlement without more legal analysis.

"We don't want to necessarily jump at the first offer to come in front of us if there is an opportunity to recover more for the taxpayer," Levy said.

New York Attorney General Eliot Spitzer last year sued the company, the nation's third largest prescription administrator, charging it may have improperly kept as much as $100 million; the company claims it saved the state $2 billion.

The audit, which covers 2003 and 2004, comes at a time when the county is reviewing the proposals from three firms, including Express Scripts, to administer the prescription plan after the current contract runs out at year's end.

Association of Municipal Employees president Cheryl Felice, co-chairwoman of the labor-management committee that oversees the county health plan, expressed confidence the issue will soon be resolved. "The committee is looking for some closure since this audit has been pending for a year and a half," she said.



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Fighting for the Little Guy, Part 1

Fighting for the Little Guy, Part 2






EditorMom

3 comments:

dubaltach said...

Record your conversations with them tell them you are recording the conversation first and tell them that the recording and a transcript are both being delivered to your lawyer.

Offer to send them a copy of the transcript.

If they refuse demand they escalate (refer upwards) the call to their supervisor. Keep escalating until you get someone who is willing to be recorded.

This is what my father does - it works very well.

Katharine said...

That is a good plan, Dubaltach, and I've used it in the past. But Express Scripts thinks it doesn't have to care because it's the third largest mail-order supplier in the U.S. Back in March, I reported them to a profession-related oversight agency, but I've seen no changes. They've received a copy of the main post in modified form when I sent it to the editors of various national newspapers and news magazines. We'll see what happens next.

Anonymous said...

It is 2009 and Express Scripts is still going strong!

They will tell you anything to avoid filling expensive prescriptions. I have caught them in several outright lies.

They have made substitutions of drugs for my co-workers without contacting the doctor or notifying the patient.

Anything for another dollar at the expense of the patient.

The lawsuit they lost in 2008 had no impact on the way they do business.

It is scary to think they continue to abuse their patients and no one is stopping them!

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