Why do medical insurers push mail-order drugs??

[bluebirdy]

We get several solicitations every month from our medical insurer trying to get us to switch to doing the 90-day-mail-order thing for our Rx's ... usually sent in duplicate to me and my husband. So they're spending a lot of money to do these mailings.

This can only mean that mail-order-drugs are MUCH less expensive for insurance companies. Why? WHERE do they get these drugs? ... that make them so much less expensive for the insurance companies?

What is it WE don't know ...

bluebirdy

[Mark N]

The medicines are much cheaper because mail order companies buy in large bulk and get better prices as a result. Therefore they can charge a lower price while still maintaining their profit levels.

[Pharmacist.steve]

Mail order is a different "class of trade" - there are about 4-6 different classes of trade within the Pharmacy industry. You think you get junk mail now ... just sign up for a mail order pharmacy ... they also get "rebates/kickbacks" based on increase in market share for a particular drug or drugs from a single company... so you and your doc will start getting requests to move to this 'better" therapeutic alternative.. if you are taking Crestor or Lipitor .. they will start pushing generic Mevacor or Zocor

Here is the dirty little secret that they won't tell you ...

The FDA requires that most drugs are stored between 58 - 82 F.. the manufacturer is required to do this .. the *********r is required to do this .. the pharmacy is required to do this... BUT ... once the pharmacy drops your medication in the mail... there is NO ONE responsible for keeping your meds at the right storage temp.

There was a study a few years back and they found one inhaler - in particular - lost 50% of it potency because of the heat encountered in the mail.

And if you have a problem... just tried to get it resolved with a email or phone call.. with people you don't know.. don't know you .. and probably could care less about your needs/wants

[Peter B]

Capitalism.........You gotta love it.


Pete

[bluebirdy]

Thanks Pharm Steve - more kickbacks for these mail-order drug companies, eh?? ;) Knew there was more to this. After all, the big pharmacies like CVS and Walgreens etc. ALSO presumably buy in bulk ... so it has just never made sense to me why such a CONSTANT push from my insurer to change to a mail-order provider. And more junk mail??? Oh gosh - that's all we need.

I've not given thought to the temp concern. Thanks. The reason I have NOT switched to mail order is common sense and experience telling me what a nightmare it would (will?) be when my month's order doesn't appear at my doorstep :eek:

thanks, bb

[mrsdoubtfyre]

with mail order. In fact my husband who is a Federal Employee had mail order LONG before the general public. Ours was National RX Services in Tampa Fla. about 20 yrs ago.

Typically mail order pharmacies get their drugs at a discount, less $$ than local ones. In the past when it was a smaller operation, we had no problems with it.

But now we have the similar issues. Medco is the pits...and 2008, has become our mail order for the 2nd time. I am not happy. Professionally I saw the worst issues with them. Given that seniors were almost forced to use them, and that the meds never came on time or AT ALL... it was a nightmare.

The last two years we had Caremark. However in the fall they refused to fill an RX for me for lisinopril 40mg... said it didn't exist. That did not sit well with me, I'll tell you.

Today I cannot tell you one single person who likes the mail order. Even when I get my Lidoderm patches for $35 for 90 days supply, it takes over 2 weeks to come. I like that price, but I have to WAIT... and wonder if it is ever going to come.

And I have noticed that drugs are short dated from mail order. Especially the prepared eye drops/inhalers etc. Many of the generics now have 6mos on the label. So they are buying short dated cheaper drugs, to save $$. The insurance companies want control of prices, and mail order provides that.

But within the industry, they change hands frequently. They are not making that much profit either. Companies are changing hands rapidly.
CVS just bought Caremark for example.

[spondygurl1]

My company is making us do mail order(Medco) or we will have to pay the higher cost of the drugs. The only exception are controlled substances and my pain doc said they won't do itfor Norco ,Vicodin ,fentanyl or Xanax which are 4 of ours, hat leaves usw/Nexium,inhalers and Topamax. My pain dr has to see us every other month and said the only one they will agree to do mail order on is the Topamax. I was so happy.I just know the insurance is gonna have a fit though because I won't use them for the vicadin or Norco which are on teir list but the drs won't write for it. Yeah!!

[BrokenBladder]

I personally have Caremark and they would like me to use their mail order system for most of my meds, but I had a situation where it took a month to get my meds!!

Now I'm interested in the buyout of Caremark by CVS. Wonder if I can go to CVS and get the discounted prices that I would normally get in mail order?

[mrsdoubtfyre]

Here are some tips to speed up mail order:

1) write all your information, date of birth, Ins ID number, clearly spell your name and address, tele. # on the RX ....

2) look at your Rx BEFORE you leave the doctor's office.
It must be dated, and with the correct day. It can NOT have any strike overs, and must be legible to you. If any strike overs are there, or any hard to read
numbers, that Rx will go into a phone verification pile and be VERY delayed. Undated Rxs go into that phone pile too...this is very important.

3) Don't assume they will fill everything. If you have an unusual RX, an injectable, Lidoderm patches, any patch, a weird new item, ointment etc, call first their toll free number and verify that they have it and will fill it. Some places do not fill/accept Epi-pens, for example. It can take up to 7 days for them to mail an RX back to you that they cannot fill for whatever reason.

4) What I do is put a stickey note on the RX and say, this is my blood pressure medicine, blah blah, and I use it regularly, etc. I will accept generic, and I reprint on the note what the doctor is giving. This is to minimize it going into the telephone pile, which greatly increases the turn around time for you receiving your meds.

5) It is my understanding that controlled substances are ALWAYS called by phone or fax for verification. At one time all RXs were (back in my 20 yr ago
days with National RX services). But I don't think they call on all of them now.
Anything very high dose, or huge dispensing # like #360 tabs etc they will call on. So if you have something that fits this category, you must have a back up plan locally. Make sure your doctor understands this and will give you enough to hold you over --over the phone. For non controlled substances I often have people get an RX for 30 days supply from the doctor to put on file in case your meds don't come in time. Then you can use the emergency RX.
For Topamax for example. But they won't typically do this for controls.

6) It is wise to count your received meds carefully. If they make a miscount they need to be notified sooner rather than later. Days supply is critical for insurance companies. You might come up short, and have to pay for the difference. So I count all my meds carefully.

7) Check expiration dates on all your received meds...they are often short dated now. If you are running a little ahead (which I try to do) you may just hit an expiration date. (I travel in the summers to a remote place and do not have mail box...I use a marina then. It takes them 3 weeks to ship anything there:( )

I hope this helps...

Regarding the CVS acquisition of Caremark Mail away pharmacies.... I think this only applies to the pharmacies, not to the INSURANCE portion of
the company. In our case we use Caremark in the drug store, for the pharmacy to connect to the computer for our Federal plan (Blue Cross)
The mail order PHARMACY is now owned by CVS. It gets a little mirky. So we have THREE companies to deal with now. Blue Cross/Caremark in local pharmacy/ and Medco for mail away. Like I said before nothing is straightforward or easy anymore anywhere! (Caremark lost the bid for 2008 for the Feds)

[Diandra]

Good Thread.
Steve, thanks for enlightening us about the temp issue as I was not aware of it.

I have Medco and did find out, your doc can fax the script to them as long as they have all your info(name, dob, etc.). Medco suggested I do it this way after a script of mine that I mailed in was delayed.

Also, I know Medco can be a pain but, they will work with you, it is just the extra effort that stinks. I called them directly for Botox for my trigeminal neuralgia and I saved money on what it would have cost if I let the pain doc get it himself. Recently, the Norco they sent was from an inferior maker and Medco does not use that generic so my doc wrote it from Watson Labs and Medco authorized I could get it each month from my local pharmacy at the Medco prices....so, they do work with you and they were nice about it to.

I have never be comfortable with getting mail order narcotics. My mailbox is at the street at the end of my driveway. Anyone could walk by and help themselves. The feds are so worried about opiate abuse yet it gets mailed all over the place...don't understand that.

Bluebirdy....sorry we veered off your original topic.

Diandra

[bluebirdy]

Good Thread.
Steve, thanks for enlightening us about the temp issue as I was not aware of it.

I have Medco and did find out, your doc can fax the script to them as long as they have all your info(name, dob, etc.). Medco suggested I do it this way after a script of mine that I mailed in was delayed.

Also, I know Medco can be a pain but, they will work with you, it is just the extra effort that stinks. I called them directly for Botox for my trigeminal neuralgia and I saved money on what it would have cost if I let the pain doc get it himself. Recently, the Norco they sent was from an inferior maker and Medco does not use that generic so my doc wrote it from Watson Labs and Medco authorized I could get it each month from my local pharmacy at the Medco prices....so, they do work with you and they were nice about it to.

I have never be comfortable with getting mail order narcotics. My mailbox is at the street at the end of my driveway. Anyone could walk by and help themselves. The feds are so worried about opiate abuse yet it gets mailed all over the place...don't understand that.

Bluebirdy....sorry we veered off your original topic.

Diandra

Diandra - I think everyone's input is very interesting so no problem. You said:

"Recently, the Norco they sent was from an inferior maker ..."

That's one of my concerns. Who figured out the maker was "inferior"??

btw, so sorry about your trigeminal neuralgia. I've heard how very difficult that can be. You take care,

bb

[Diandra]

Hi BB,
I was taking generic Norco made by Watson labs, who is the maker of brand Norco. I have taken it on and off for years. With my prescription company, Medco, after 3 script refills at the local pharmacy I have to use mail order Medco....so, I did.

They mailed my generic Norco from a company that was not Watson(something like Mallinkroft) and honestly, I did not even notice at first. Then, it was not covering my pain as well, and causing me some stomach discomfort.

I talked to my pain doc about it and he said that other patients had complained about that particular generic Norco as well so when he wrote the script he wrote it for Watson generic Norco. So, I guess you can say me or anyone who uses that drug considered the product inferior, and my doc knew it as well.

Like I said, I called Medco and told them I needed Watson generic Norco and they did not carry it(I am sure due to cost) but, they said they would have it notated in my file that I can get it from my local pharmacy and at the Medco price. I was actually surprised they did not give me a hard time about it. They even said to call the pharmacy and make sure it has Watson Norco before I go.

Diandra

[Mark N]

Diandra, I stay away from Mallinkroft sp? as their reputation is not very good from what I have read. I asked my pharmacist about them but he hadn't heard anything on them because they don't carry generics by them.

[RJW]

i really liked getting my meds through express scripts. I could get my meds quicker, cheaper, and with less hassle. I used to have to pay 2 copays to get 3 months of meds: $60 instead of $90 but they changed it to $75 for $90. It is still worth it to me though.

[PAINJOURNEY]

Diandra-

Almost ALL Mallincrot? meds I took gave me problems. (it took me a long time to figure that out, it was actually the pharmacist that told me)

On the other hand, most Watson generics to me, are as good as the brand name.

Painjourney

[Kandra]

If I went mail order I'd have to use Walgreens mail order due to that's who the feds (employer) picked for this HMO/area or whatever. However, my copays per month come to almost $600 and there's no way I can come up with the amount of money I'd need for three months of meds. The pharmacy section of the HMO told me it would not be financially beneficial to me to change over. I know that I'd get 3 months worth of meds with 2 months worth of copays but I can't afford $1200 at a single pop.

As some of meds are inhalers, that's good info to know about it losing it's potency..something I need to pass on to my pulmonologist I think. When he's writing out scripts the first thing he always asks is if I'm using mail order.

[Pharmacist.steve]

reference article

http://www.webmd.com/healthy-aging/news/20041027/mail-order-drugs-may-lose-potency

[Kandra]

Thanks, Steve!

I'm going to print that out and fax it to my pulmonologist's nurse.

[bluebirdy]

I've learned so much from all of you about generic drugs! On my other thread on generics I finally learned that the generic manufacturer name is ON MY RX BOTTLE but in teensy-tiny print that's almost always covered with a label :rolleyes:

About Mallinckrodt: Interesting what you all have discovered with their drugs. Also on that other thread on generics someone put a link to M's website. They make my Hydrocodone I learned. I went to their website and here's what they say:

"Mallinckrodt Pharmaceuticals Generics is the 5th largest manufacturer of generic pharmaceuticals in the United States with more than 107 million prescriptions dispensed annually.* Our hydrocodone family of products is the most dispensed generic pharmaceutical in the United States."

bb

[bluebirdy]

My doggie just had a 2nd seizure due to the incompetence of her now-previous Vet in giving her Phenobarb ... and I had just hung up the phone talking to her Vet about another drug we've got to add immediately.

The phone rang again and I grabbed it thinking it might be the Vet calling back. Well - it was CIGNA ... calling to push me to mail-order our Rx's :mad::mad::mad: As I've told you all, they write us CONSTANTLY trying to get us to do the mail-order thing.

I told the Cigna woman that I wasn't interested because I wasn't going to deal with someone long-distance when my drugs didn't arrive and all the worries that go with that. Her reply? They're our insurance company and they're looking out for me. Ain't that a hoot ...

I then told her it was VERY bad timing because my dog is sick, just had a seizure. Her reply? Oh, I have your records right here and it won't take but a minute ...

Yeah, they're REALLY looking out for ME :mad:

bb

[Pharmacist.steve]

I then told her it was VERY bad timing because my dog is sick, just had a seizure. Her reply? Oh, I have your records right here and it won't take but a minute ...

Yeah, they're REALLY looking out for ME

I guess they missed the point of NO MEANS NO!!!

Have your tried calling their customer service and telling them to take you off all "promotional" material??

IF they can't - won't .. check with the state insurance commissioner as to your rights to stop them harrassing you

[FLGIRLINPAIN]

Hi BB!

Wow, I'm so sorry about your dog. Hopefully, she will feel better soon and I will add her to my prayer list.

We have Cigna Insurance as well and are constantly receiving "junk mail" from them regarding mail order Rx's. Thank goodness, we have not received any phone calls from them. When did they start doing this? That is getting ridiculous, I get enough solicitors calling even though we are on the "do not call" list. That really makes me mad!

Take care and thanks for the interesting thread.
FLGIRL

[bluebirdy]

"IF they can't - won't .. check with the state insurance commissioner as to your rights to stop them harrassing you"

Pharm. Steve - that's a GOOD point! It IS harrassment! Cigna comes up on our caller ID all the time. And just the evening before when hubby brought in the mail - yep! - there was yet another mailing about their mail-order program :mad:

FLGIRLINPAIN - I really truly appreciate your prayers for our doggie. She was on a huge first dose of her new drug yesterday that I had to pick up at a compounding pharmacy, and goes to maintenance on that today as I titrate down her Phenobarb. And she's taking my 2mg Valium at the Vet's request - a dose that hasn't done a thing for me :rolleyes: She made it through the night without a seizure - woo-hoo!!

thanks, bb

[Nana4&cntn]

Hi All,

I also had cigna, was able to change the first of the year, I still get stuff. I called the company and threatened to sue if I got 1 mor call, or info in my box. No more news from cigna. I know how irritating it is to get calls all day long, especially when not feeling well. I actually cussed on poor girl. She had awakened me from the only sleep I had had in 2 days. I just despise computer dialing.

FLGIRL,
I had a huge golden retreiver with a seizure disorder, it is terrifying to watch happen. I filled scripts at a local pharmacy. I hope the vet told you to NEVER try to hold your dog down, or give meds during a seizure. Both of these things can cause injury to yourself and your dog.

Hope this find all of you well,
Kathy

[bluebirdy]

I've had TWO MORE CALLS from Cigna already ... just this morning ... after what I wrote about above. They must spend a fortune nagging people and I bet lots of people give in to them just to get the calls and junk mail to stop.

bb