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Friday, July 19, 2024

Blue Defend CA, CVS Caremark & the thriller of the additional $116 – The Well being Care Weblog


Blue Defend CA, CVS Caremark & the thriller of the additional 6 – The Well being Care Weblog

By MATTHEW HOLT

At this time we’re going to have enjoyable with present and inform. I’m going to point out you the way somewhat nook of American well being care is making my life as a shopper worse and costlier–hopefully somebody can inform me why.

The forged members are: me, my MD, the (form of) unbiased pharmacy that delivers, Alto, and my insurer Blue Defend of California and its PBM CVS Caremark, which additionally owns a mail order pharmacy.

The transient backstory: For some years my physician has been whining about my excessive ldl cholesterol, and some years again I went on a statin known as Rosuvastatin Calcium. Older readers might keep in mind Jean Luc Picard himself promoting the branded model Crestor, but it surely’s been off patent for a couple of decade. About 50 million People now take a statin, virtually all of them a generic, together with many 60 yr previous males like me. My ldl cholesterol has come down, however my MD informed me it may come down extra, so a number of months in the past we boosted the dose to 40mg from 20mg. 

Till just lately I’d been insured by BCBS Massachusetts, and also you may recall somewhat over a yr in the past I wrote a bit on THCB concerning the enjoyable and video games available making an attempt to determine what their PBM (CVS Caremark) was doing with the pricing of my child’s ADHD medicine. However they’d by no means messed with my medicine as my statins are low-cost. Not less than I believed they had been. In truth as just lately as April final yr, they had been free. You may see the value from the supply from Alto Pharmacy under.

How BCBS Mass got here up with $0.00 as the value I pay I don’t know, however presumably they assume it’s a superb factor to have me on statins within the hope I don’t have an (costly) coronary heart assault as a substitute.

Then for some purpose my worth for the statin later the identical yr went as much as $23. Not $0 however at $8 a month probably not value making a fuss about.

On the finish of the yr, COBRA expired and I went to purchase insurance coverage on the California alternate. And to be able to maintain entry to my household’s medical doctors at One Medical, I selected the one plan they had been in, the Blue Defend of California HMO.

My subsequent 90 day provide was the primary one which went from 20mg to 40mg, but it surely’s nonetheless a typical generic. Blue Defend of California additionally makes use of CVS Caremark (though it’s been speaking a superb sport of ditching CVS Caremark and organising its personal PBM) and the price at Alto barely budged. Now it was $28.

What occurred subsequent: So all was going usually till late final week when my subsequent 90 provide was delivered. Besides it wasn’t. Alto delivered me a 30 day provide and charged me $19.

Hold on, why change a 90 day provide for a med I’m imagined to take on daily basis perpetually for a 30 day one?

I enquire to Alto’s message system and so they blamed Blue Defend.

And naturally Alto now could be solely allowed to fill my different meds on a 30 day cadence additionally.

So principally it seems like Blue Defend’s mail order service is enjoying hardball. They need me to maneuver my 90 day order to them. 

A diversion: Earlier than I do this, it may be value what it prices for money. GoodRx’s most cost-effective price is about $18 for a 90 day provide. However in fact I’ve to drive to choose it up, whereas Alto delivers. I’ll pay $10 extra each 3 months for that. 

Enjoyable with customer support: So now to serve the nice readers of THCB and since I’m bloody minded concerning the shopper expertise, I resolve to search out out from Blue Defend what is definitely taking place. (I additionally dwell tweeted the enjoyable and video games)

“I’m on with @BlueShieldCA maintain music. Let’s see how they do compared with South Park….” (I’m certain you’ve seen the South Park model by now)

The reply just isn’t properly. BCBS Mass had a chat perform, if no AI. Blue Defend of California has a cellphone line. With voice recognition that, properly, doesn’t work.

After they ask me my date of beginning and are satisfied my sixty is a fifty. It’s additionally obvious their voice recognition can not perceive “NO” and but they’re so assured it’s good they received’t let me “Press 1 for sure or 2 for no”. However they’re pleased to inform me that descriptions of advantages will not be a assure of fee & I  ought to schedule a wellness go to–though they acknowledge my cellphone quantity and so they’ve already paid for a wellness go to this calendar yr. There’s over three minutes of irrelevant messaging, then 90 seconds of additional identification which doesn’t work as a result of it nonetheless can’t inform my beginning yr.

Blue Defend the tech chief: In its public pronouncements Blue Defend is claiming that it’s updating its tech. In truth Exec VP Peter Lengthy has been boasting about it on Linkedin

The common tweet reader might recall them earlier this yr sending me 5 an identical letters to inform me that I had modified my PCP, which I had informed them within the first place!

You could surmise that I’m not seeing their tech upgrades as bettering my expertise…but.

So again to my statin. You’ll recall that it appears Blue Defend transformed a upkeep statin I had been receiving from Alto Pharmacy to 30 days with out telling me, and with out permitting Alto to fill it for 90 days. Presumably they wish to transfer this to their PBM/pharmacy to maintain the revenue.

My price for 90 days was $28, for 30 days $19. So if I saved it with Alto my annual price would go from round $112 to $228. So if I did nothing somebody can be conserving the additional $116.

You could recall that I used to be on maintain. An agent got here on the road ultimately and informed me I’ve to talk to the pharmacy. After being on the decision for 22 minutes, somebody got here on and their opening phrases had been to inform me that Blue Defend, “not us”, insists that I get this drug by way of mail order. So who’re “you” I ask? “CVS Caremark” they are saying. So “how do I get my Rx by way of CVS Caremark” I ask? You are able to do it on the Blue Defend website. And when you hunt round a bit you may.

So I gamely click on through on the Blue Defend website, by means of to the CVS Caremark sub-site for Blue Defend, register with my ID quantity on the CVS Caremark website and get this:

This has taken me 26 minutes on the decision, (not counting the primary 5 min name that dropped), 10 minutes screwing round on the @blueshield & @CVSHealth website, and naturally the 2 websites can’t talk…and so they invite me to name again.

However as a result of I’m a sucker for punishment I attempt once more, and see if I can determine another method within the Blue Defend website. There I discover a drug pricing instrument.

I want to know the price to me of shifting to the CVS Mail order. The instrument is aware of the medication I’m on! I ask it for the value of my statin and it tells me it’s $19 for 30 days provide–the each worth Alto charged me. It additionally tells me I can get 90 days by way of mail order! 

So I click on on that hyperlink and now it sends me to @cvspharmacy (once more) , which lets me click on on a current Rx I’ve crammed (I assume primarily based on the declare from February) to see what the pricing is by way of mail order.  

And naturally you may guess what the response is.

The reply is that 90 days provide just isn’t obtainable in a retailer and apparently neither is 90 days provide obtainable by way of mail order. And for this fabulous expertise they wish to cease me utilizing Alto Pharmacy. Presumably they need me to pressure my physician’s workplace to resubmit the Rx to CVS mail order. 

In case you are nonetheless conserving rating, someplace between Blue Defend and CVS Caremark, for a upkeep drug that they wish to encourage me to be on (I assume), which prices them virtually nothing to accumulate, they need me to alter pharmacy and/or trouble my physician.

We nonetheless received’t know if it really works, and for that matter it’s uncertain who will get the additional $116 if I am going again to 30 days at Alto.

And naturally it will be simpler and cheaper for me to pay the $11 + delivery it will price me to purchase 90 days provide at Mark Cuban’s Value Plus medication. However then it wouldn’t depend in opposition to my deductible, and my insurer, who presumably is meant to care about my well being and my Rx adherence, received’t know what medication I’m on.

I hope you’ve loved this little journey by means of this obscure nook of the American well being care system. Bonus factors when you can clarify why anybody would wish to undergo this, or what the hell Blue Defend or CVS Caremark are gaining for making me do it.



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