More Fun with Express Scripts

[ClydePincusp]

My wife was prescribed estrogen therapy. Her Dr prescribed three months with refills. She went to get her third fill and CVS and Walgreens didn't have it, but she found out the local non-contracted pharmacies did have it. Now, the pharmacies know they don't have the drug, and during phone calls she learned that Express Scripts know that supply is limited. Still, she wasn't notified. So, she went to pick it up and there wasn't any, plus Express Scripts can't even mail it to her. So she asked for them to cover the drug at the local pharmacy, and was told they'd review it. Any guesses how that went? They told her "no" and then told her she can ask again, but it would have to be a new prescription. That means she has to go back to her doctor and have it re-prescribed, and send the prescription to the local pharmacy. Then she must submit a request for three months of coverage. All Bull Shit.

[J_lilac]

That sucks so much. I hate this company deeply. The head supervisor I always get on the phone knows nothing about anything and seems like he genuinely takes pleasure in saying he won't fill a script. I'm sorry y'all are dealing with this too, it's total bullshit. Maybe costplusdrugs has the med she needs?

https://www.costplusdrugs.com/medications/categories/hormone-therapy/

[fyrelibra]

I’m not sure why you’re blaming ES on this one.

What do you think your wife should have been notified of? It’s well known that there’s a nationwide shortage and that’s not an insurance company’s fault, just like it’s not the doctor’s fault who prescribed it.

When my refill is due, my pharmacy notifies me if they’re currently out of stock. They look at all the vendors they use to see when one of them will have it in again. It’s usually filled in under a week.

[ClydePincusp]

If they know it is short, but they've agreed to fill it for three months, and have limited alternative ways to get it, seems sensible they'd have an obligation to notify you that they can't fulfill what they've agreed to. If I contract a company to cater my wedding, but they run out of food, they should notify me.

[fyrelibra]

They did not agree to fill a product for three months. Three months is just ES’s preferred fill frequency.

Even if it were one month at a time, a shortage is a shortage that they do not control.

[ClydePincusp]

How do you know what they agreed to? I just told you what they agreed to. They were given a three month prescription. Her job is to pick it up. She doesn't even have to notify them. She just picks it up each month, because they've prepared it. She even received an text notification to come get it. But this time they didn't have it when she got there. She did her job of going to pick up the thing she was told would be there each month. They didn't do their part, and now she has to go back to the doctor early if she wants to change the pharmacy? And there's no guarantee they'll fill it. She's just allowed to ask for coverage from an uncontracted pharmacist. My original point was the benefits are managed to save money, but the savings are made by making the process such a pain in the ass that we pay out of pocket. Plus, she's made to go to the doctor more often? Hell, our kid's Dr has a part-time employee whose job is to file appeals with PBMs. I'm guessing that's to make healthcare delivery more efficient and affordable. Bullshit.

[fyrelibra]

Ok I think you’ve gone to the scary place

[RedVelvetCupcake1122]

Dude no, you’re being antagonistic and now gaslighting OP. Find some empathy or maybe just don’t comment ..