Mail order pharmacies

Since the new year my now primary prescription plan offers some incentives to use their mail order pharmacy— 90 day supplies (of any med) are limited to a copay of $75 as opposed to retail pharmacy where there is no limit and the copay is for every 30 day supply— so in terms of insulin pens, a box costs me about $85 at a retail pharmacy, where 2 boxes cost me $75 through mail order.

This seems like a no-brainier, but given my life’s experience of a commedy of errors regarding important things, I’m pretty hesitant to go the mail order route. I find comfort in the idea that I can walk into the pharmacy and straighten things out. In a small town they have a working relationship with my wife, a medical professional. That I myself am a somewhat known person in this town who’s needs they’d take seriously, That I could get ahold of the actual pharmacist himself and explain any issue that comes up if needed, they’d do their best to smooth out any mix up, etc…

My fear is that with a mail order pharmacy this wouldn’t be the case and there’d be layers of stupidity between me, my doctors office, and my medications…

Looking for insight from people who know from experience. Have mail order pharmacies ever become a nightmare for you? Have they been great? Any other thoughts or comments?

I’ve used a mail order pharmacy for years. Not for pump supplies but for medications and insulin. My mail order service provider is CVS Caremark which has a dominant position in the mail order pharmacy market. There have certainly been a few hiccups but overall things have worked out well. My insulin always comes in very carefully packaged insulin containers, I’ve never had a problem. If you do have a problem you can call and talk with a pharmacist.

The biggest problem I’ve had is making sure that I actually “review” the prescriptions. These days my prescriptions are sent directly from my doctor to Caremark. If there is an error made you won’t notice it until the wrong prescription arrives at your door at which point it is nearly impossible to fix. This has happened when my doctor ordered the wrong number of test strips for me. I was never able to fix that and hat to “eat” the copay and get a corrected prescription sent. My understanding is that in the case of an actual error by Caremark my insurance can approve an exception allowing you to go directly to a local pharmacy without incurring the 30 day co-pay.

These days I have my doctor print out the electronic prescription during my visit. She then has her staff enter it electronically to Caremark but I have proof of what the actual prescription from the doctor actually is.

ps. Another note, when using mail order pharmacies you can almost never use a “savings card.” For instance there is a Humalog U-200 savings card, but I can’t use that with Caremark.

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For the last two years, I have been forced by my insurance to use a mail order pharmacy for some prescriptions, such as insulin – they refused to pay anything at all for a local pharmacy. As @Brian_BSC pointed out, that prevented me from using the savings card, which for Apidra would have meant ZERO copay for me. Despite that, I had a problem with the mail order pharmacy only once: When I switched from Novolog to Apidra, they ‘auto-shipped’ the old prescription before processing the new one. Took a few phone calls, but they shipped out a replacement order AND authorized me to get an emergency 30-day supply at the local pharmacy, and I had to ship back the Novolog for disposal (at their expense).

Currently, I have to get ALL my supplies by mail. Worse, I have four scripts that come from four separate vendors: insulin frome one, Dexcom supplies from another, pump supplies from a third and test strips from the last. I had a problem with the one that supplies the Dexcom supplies a couple times, but in July, my insurance started allowing walk-in Dexcom orders, at which time the mail order shop got their act together – I think they don’t want to lose the business. It’s a bit disconcerting to get all these essentials from different suppliers, but overall, I have not had many problems.

True. I’ve never come across an exception to not being able to use copayment discount cards with mail order pharmacies. So you need to factor that in to your cost comparison.

My only worry would be whether the integrity of the insulin was compromised. I know of several people who received soggy boxes containing “melted” cold packs and denatured insulin during a very hot summer or partially frozen and useless insulin during a harsh winter. Much like a piece of candy found lying on the ground, you don’t know where that insulin has been or for exactly how long it’s been at any particular destination along its journey. But the same can be said for the insulin you get at your local pharmacy, however.

That’s been my concern. So far, I have not seen a problem, at least with the pharmacy from which I have to get insulin. They pack insulin in a very think foam cooler with cold packs, and it ships overnight. What I don’t like is that they just leave a box containing nearly $3000 worth of insulin on my doorstep; however, with no one at home frequently, the alternative could be quite inconvenient. So far, I have received all my orders in good condition – I hope that continues.

Of course, I have heard of some people having problems with some pharmacies. I think shipping conditions should be part of the discussion @Sam19, should you try the mail order route.

Yes, I’ve gotten two vials of denatured Apidra from our local pharmacy over the past two years, so it’s basically a crapshoot whatever you choose…

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I’ve used mail order exclusively for as long as I can remember. For the vast majority of my orders it has been seamless, but there have been cases where it’s been a complete pain. For example, trying to make the switch to Tresiba. Really the issue is making sure the mail order has everything they need and then me having to be the intermediary with my doctor when an issue arises, which can be challenging.

Overall, I’m very happy with the 90 day mail order.

It’s also CVS Caremark that would be my mail order service. I also find concern about not having the opportunity to review the prescriptions before they’re submitted— I was thinking I could request paper written rx slips from the doctor and mail them in to Caremark myself to minimize some of the potential for screw ups…

Mail order prescriptions are a good value and convenience but sometimes they can be very frustrating. A lot of my frustration came from the fact that I live on a boat and do not have a physical street address. My US Post Office is now authorized to receive UPS and Fedex boxes for me so that part is solved. I use the Post Office street address as the delivery address.

But my last mail order firm, Express Scripts, didn’t consistently deal well with a customer that used both a mailing address (my PO box for bills) and delivery address for boxes. I would often get automated calls from a depot pharmacy saying they couldn’t deliver to a PO box. I would have to call in and get through all the phone mazes to finally talk with a person that understood the address mix-up. But then 90 days later I would be going through the same exercise. It’s like this organization could not learn from its mistakes.

These mail order prescription companies are called “pharmacy benefit managers.” That means that they’re trying to save the employer money. I’ve had them call my doctor’s office and talked with a nurse that was just filling in for the day. They got this nurse to agree that I didn’t need as many strips as the doctor ordered. I ended up making heart-burn calls to the pharmacy and doctor himself about hat case. I told the actual pharmacists that if they ever solicited medication adjustments without an issue of illegibility or medical safety like drug interactions, that I would go after her pharmacy license for malpractice. That short order of strips was quickly corrected and I had no further problems.

I don’t have any choice about dealing with mail-order pharmacies. They are economical and very convenient when they work. I just need to keep reminding myself to be patient!

I hadn’t even thought of that Terry… I encounter these issues FREQUENTLY living where I do— the Usps doesn’t even do residential delivery here— and I frequently am told by ups and fedex that my physical address “can’t be verified” etc…

Also, often I’ll use my physical address when someone wants to ship with ups or fedex, then when they see that it costs about a hundred bucks to send a box of tic-Tacs here with ups or fedex, they switch it to USPS, who don’t do residential delivery here… And the whole process becomes a mess—
Rural Alaska issues…

That’s a big potential headache for me too

I personally do not like mail order pharmacies. Only had a couple actual problems. The worst was when I came home from work during a summer heat wave and had a notice on the door of a second attempt to deliver insulin. Never got the first notice. So by the time I got the insulin, it had been in the UPS truck for three days. Don’t have to tell you what condition that insulin was in.

I think I’m finding myself in the clutches of anxiety just since I decided to mess with this idea… I’d rather spend a little extra money and stay local as long as I can afford it I think…
Maybe try it with something nowhere near as important for a while before I trust them with insulin. I might feel differently in different situations, but currently I have a lot more money than I have patience…

@Terry4 deciding to buy my own strips out-of-pocket was one of the most liberating decisions I’ve ever made— and it really didn’t end up costing me much, if anything, in the long run… Probably better for me in the long run too because situations like you just described would stress me out a lot

Caremark is well known in my household as CareLess.

As @Brian_BSC noted, you are a beneficiary, but not the customer, so they are more focused on reducing their perceived costs than satisfying the actual users of the prescriptions they send out.

The key to success with mail order is understanding that Caremark has a factory-like process. If you are the square peg, they will want to fit you into the round hole. So you have to work on rounding out the corners. Once you do that, it should work with your constant vigilance.

for me i get all my stuff from my pharmacy. but my Dexcom supplies i get them from a mail order pharmacy. & i don’t have that many problems. i ues to have a lot of problems.

Well we will see how this goes, my doc wrote out a script For 90 day supplies (and he was quite generous) of tresiba and the new novofine plus pen needles I’ve been raving about. I submitted it with the cvs Caremark smartphone app, so I actually still have the script in hand in case they screw it up I’ll have recourses… I tend to be apprehensive of change

I’ve been using mail order for almost two years. It definitely requires being on top of reorders and expecting the unexpected. The only time I had a problem was when I placed my order, there was some issue with it and the pharmacy had to contact my doctor, that delayed things, and the shipment was sent while I was out of town for a week. Came home to insulin in my mailbox and I didn’t know for sure how long it had been sitting there with the cold pack no longer cold.

I didn’t go with completely out-of-pocket for strips, but went ti Livongo, which has essentially the same liberating effect regarding test strips, anyway.

Care to elaborate re: livongo? How does it work?

Sam &/or Others As a protest against the UnAffordable Health Care Act and the HIGHER premium costs I have switched to a Christian Health Share Plan which is much like a Catastrophic Plan. As medications and supplies are not covered can you suggest what Test Strips you find most Out Of Pocket affordable? I’m already cued in on Insulin Savings Cards as well as Walmart’s reasonable Humulin prices as well as benefits of dealing directly with Dexcom. Was hard enough to decide to insert a CGM sensor and I will continue to refuse adding a pump.

A mail order success story here. My mail order does all the work for me, they let me know when an RX is on it’s last refill, it’s time to re-order an RX, and they contact the doc when a new RX is required. All I have to do is receive the medications. I’d rather have a 90 day supply delivered to my door than have to gas up my truck and go get them :slight_smile: