It’s because you are not their customer. You are the beneficiary and that makes a difference.
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So you’re basically paying extra to be ‘somebody’s’ customer at a local pharmacy is one way to see it I guess
@Sam19, the local pharmacy wants you to be their customer for more than just your prescriptions, plus they get paid by the insurance plan for your script.
The PBM contracts with whomever your self-insured plan is, and they may receive a bonus if they hold costs below a certain threshold, plus they have all these metrics that some bean-counter says yields lower costs to the PBM. My n=1 experience says that some of the call center “savings” must be pretty mythical though. Anyway, you are just a beneficiary to be managed and maybe enticed to ask your doctor to write more scripts for stuff like statins. After all, more drugs WILL increase their bottom line.
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The one bright side of this arrangement in my plan that I just very recently discovered is that the trustees of the plan can override any Caremark BS when I ask them to directly. I’ve only had to do this once but they made it abundantly clear to me that they’d do it any time it was legitimate with zero hesitation-- I have a very good insurance group thankfully…
That’s never going to happen to me buying generic strips with cash— and in my opinion they’re as good or better quality than any other on the market. That’s one headache I just don’t need.
I’ve a few challenges but like PrimeMail quite a bit, it is much less work than driving back and forth to the pharmacy. Last year was super easy as, when I switched docs, the new doc called in an RX so I was awash with supplies all year. I don’t know if this year will be the same but I have encountered minimal problems. I call, they ship, the stuff arrives. The same goes for pump supplies and sensors, although I get those and test strips from Medtronic. They seem to be a bit better at math. I ran into a some “barrier” and got a partial refill for the last one of the year but they shipped the rest shortly after the first of the year, before I got around to calling PrimeMail to rant at them.
I use Caremark as well and had trouble recently when my doctor changed my needle script from Novotwist 32g 5mm to 3mm- apparently they don’t come in that size. What was disconcerting is he wrote a paper script that I mailed in. When I called the tech she said they had no record of receiving it and would get back to me, which she never did. I called again and spoke to a pharmacist who shared that the size the doctor was requesting is not available. I researched it and found the Novofine plus needle caps you are referring to and chose the option to have Caremark request a script from the doctor. I emailed him to let him know to expect the fax. That was a few days ago and have heard nothing so likely will wind up calling my doc myself to ask them to fax. When the process works the mail order is efficient, but can be a headache when it doesn’t.
I have had similar problems every time Byram needs a new script. They tell me that faxed in the request, but the doctor never seems to receive it. I have to call and have them send the request “again” - sometimes multiple times - until it gets received. My doctor turns scripts around almost immediately when he gets requests, but it’s a bit hard when the request never shows up! Note: he never has had trouble getting scripts from other vendors…
Once the initial script goes in from the doctor does most of the back-and-forth take place between the doctors office and Caremark-- or do you find yourself having to constantly be the intermediary to get anything done?
I got an email reply from Caremark and they stated they sent two faxes to my doc and haven’t heard back. I just called the doctor and left a message for the secretary to please respond to the fax request so I don’t run out. It can go either way- if you choose autorefill they send refills automatically and if you choose autorenewal they will also contact the doctor for you. Depending on the med and cost, I choose both under the check order status tab on the left side (website). Actually the tab on the left is not check order status but refill mail service prescriptions.
Once you get the initial order set up, you should be relatively OK. When it’s time for renewal there could be some additional work required.
Apparently they had a requirement to call me and verbally counsel me that this medication requires refrigeration because I have a PO box, so that I know to check the mail daily when it might be arriving… CYA type of thing on their part. Understandable I suppose… The status now says they are “dispensing prescription” so that’s good
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i hate to ask, but do anyone have problems with Express Scripts., they keep saying i need a RX, & i know my dr send one over to them, ??.
[quote=“erice, post:53, topic:50618, full:true”]
i hate to ask, but do anyone have problems with Express Scripts., they keep saying i keep a RX, & i know my dr send one over to them, ??.[/quote]As said already I have NO troubles whatsoever with them. What is “i keep a RX”?? Docs usually fax the RX so ask yours what number they fax to and make sure it’s the right one. Good luck, I really like Express Scripts but don’t have a choice.
thanks for telling me about that, i did not see it till now.
& before i had no troubles whatsoever with them, but now i do,.& i did call them, to see what number they fax to.
Just got a shipping confirmation that it’s been shipped express mail starting from some unknown origin. Tracking number provided but not updated on Usps yet. Out of pure curiousity, and because I’m currently a man of leisure with nothing but time on my hands, I intend to pick it up at the post office immediately at their package sorting posted time and immediately open the box and shoot it’s temperature inside with my infrared thermometer. If I were more technologically inclined I’d post it to YouTube— since that seems to be popular.
I was a little freaked out by the transition to mail order process but things are looking up.
I just got my first few shipments of my cvs mail order rxs. I ordered all my supplies on the same day but have gotten shipments a few days apart… No big deal for me. I think they messed up the prescription though, because I got like 18 boxes of afrezza. When I went to the pharmacy my 1 month supply was 2 boxes… Good thing was that I only had 1 copay, bad thing is I have to figure out how to put 18 boxes of afrezza in my fridge…
I did all the rxs myself via the mycarmark site. I just searched the insulins and supplies I needed, put in a request and my doctors info, and cvs and my doc did the rest. It seems really painless to me.
Oh yeah, Sam you might want to check and see if you can pick up a 90 day supply at your local cvs for the mail order price. I can do that with my insurance, I don’t see why anyone else on the cvs/Caremark mail order benefit wouldn’t be able to.
18 boxes of afrezza! Get a second fridge if you can’t find room! That’s worth more than my truck! The nearest brick and mortar CVS is a 2508 mile drive from me, so that’s not a very good option for me.
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@Sam19 – It’s an odd yet satisfying feeling getting a new shipment of diabetes meds or gear. We enjoy a new three-month lease on life.
If you don’t mind the question, can you give the proportion of 8’s to 4’s?
I still get the afrezza locally, and somehow I get 3 month supplies (I think because my insurance deliberately did an override of Caremark policy) so there’s actually no incentive for me to use mail order for it yet— unless/until the discount card goes away.
Each box I get is 30-4s and 60-8s.