Friday, March 4, 2016

No, My Mailman Isn't My Pharmacist

Dear The Mums,

If Donald Trump and the current American political scene aren’t enough to keep you rolling in your grave, here’s something that will send you spinning.

On my way home on Thursday night, I stopped into CVS to pick up a refill for the generic version of Lipitor, which costs me about $12. When the pharmacy tech guy – someone I’d never seen there before -- rang it up, it was $98.99. I told him I was sure that wasn't the correct price, but when he didn’t offer to investigate, I swiped my card, took the bag, and left the store.  

Once home, I called the pharmacy and spoke to someone who looked at my record, confirmed that the price was not correct, and said I had a week to return, show my new insurance card and get a refund.  

So last night on my way home, I again stopped into CVS, this time to give them my insurance card and get the refund…or so I thought. Instead, the pharmacist told me that coverage had been denied because I had reached the max on the two “retail refills” allowed on my plan. Now, she said, I’d have to use the insurance company’s mail order pharmacy or obtain an override from the online pharmacy to continue to get refills at CVS. 

I’ll bet your ears were ringing then because I told her that my mailman isn’t my pharmacist and I wasn’t going to order drugs online. “I don’t disagree with you,” she said, and gave me the number to call OptumRx to request the override so she could issue the refund and give me the refill.  

When I finally was able to speak to an OptumRx rep, he talked so fast I could hardly understand what he was saying, never mind that I standing at the pharmacy counter in CVS at the height of the after-work rush. Perhaps worst of all was the chiding tone he used to tell me that if I’d “done what I was supposed to do and contacted the company in January, when they first put a “flag” on my account, I wouldn’t find myself in this position now, but by the end of the call he would be able to grant the override I requested.” He then went on auto-pilot at warp speed to tell me exactly how much I would save by purchasing drugs through the insurance company’s mail order pharmacy. 

Needless to say, none of this information cooled my boiling blood.  

Using my firmest, OMG-I’m-so-angry voice, I told him – through clenched teeth, I think – that I understood the cost savings, but I was in the pharmacy to pick up a refill. I also told him I was not prepared to use an online pharmacy under any circumstances, and that I needed an override immediately. I didn’t bother telling him that this was the first I'd heard about the limit on “retail refills” or that it’s my prerogative to fill prescriptions at whatever establishment I choose, and my reasons for doing so are not any of his ^%#^&$%$%#!#@%^ business. No, I was too sputtering mad to say any of that. 

Yes, in the end, he granted the override, and I was able to obtain the refill at CVS for the $12 I've been paying since January. So, as Daddy would say, ente gut alles gut. 


If this retail refill limit is, in fact, part of our new prescription plan, it remains to be seen whether my other maintenance drugs also will be declined when their third refills come due later this month. I’m curious to know, too, if I’ll have to jump through these same hoops to get overrides on each of those and whether I’ll have to do so for every third refill, or if the one override that’s now in place will be sufficient for all refills going forward. 

Stay tuned…and thanks for appreciating how maddening this scenario is (I know you do!) because I’m sticking by my belief (and yours, too!) that my mailman isn’t my pharmacist. 

~ Boo!  

P.S. I know I should be grateful to have decent health insurance that includes a drug plan, but the whole scene is such a racket these days that I'm miserable and frustrated in my gratitude.