We get my niece’s diabetes supplies from an on-line pharmacy, Medco, to save on copays. We get a three-month supply. Well, Medco seems to have a problem following the endo’s prescription for test strips. Sis’s insurance specifies that with a prior authorization on file (which she has) there is no limitation on test strips, i.e., Medco is to follow the Pediatric Endocrinologist’s recommendation. We are also allowed to order strips when 75 percent of our order is used up. Medco WILL NOT fill the prescription even one week early, making every shipment late by as much as a week. Medco Representatives have dictated to us the way the endo is to write the order so that their pharmacists will fill it. We have the endo put the number of tests order per day, Quantity of boxes and the preauthorization number on the prescription itself. Medco’s pharmacists have taken it upon themselves to calculate the number of strips, then realize there will be 40 strips more in the quantity of boxes and insisted on shorting us 40 strips on each order, rather than giving us the other half a box, despite the fact that the QUANTITY of boxes is written into the prescription to avoid this. Despite the fact that Sis’s insurance DOES NOT LIMIT the quantity of strips once we have the preauthorization in place. Medco is shipping our strips late every three months. We called on the 25th (which is when they would allow us to fill our order, we tried to call before then). They denied refill even though they are required to refill it when 75 percent of our order has been used. They promised to ship the strips out emergently on Monday (it was a Thursday). On Wednesday I had not received the strips. Called, spoke to Supervisor, and strips were promised to be emergently sent so I could receive them this Friday. Supervisor also cleared up the quantity issue and preordering issue in my favor. Called Medco THREE times today to make sure strips were overnighted to me. At 4:00 P.M. I was told the strips were not sent to the loading dock, won’t get them tomorrow. And they will mail them out Monday. That’s a week and a half after an emergent order. P.S. We had already bought extra strips out of pocket because she was going on vacation. In the strange position of having fantastic insurance that covers almost everything, but a pharmacy that argues with the prescriptions… Confused…
I have issues with Medco as well. But my issues are more with the laws, or requirements, that now make it almost impossible to get meds when special circomstances arise. In my mind you should not have to beg to get meds. Your example of going on vacation is a good one. No matter what it always seems we are taking vacation at the end of a refill. But like you said you can’t get anything a little ahead of their schedule. My insulin is even written that I shoudl be able to get it as needed. But they have refused me more than once. It used to be you could go explain these things to your lo9cal pharmacist and they would “take care of it”. What they did was probably against the rules but they made it work. Now, with mail order, you can’t talk to anyone who matters to figure it out.
Pain in the &^(&^.
Medco can be a pain at times. I have to use them. Get your endo to write the prescription per box per 3 months or ask the to up the amount of testing. It is great coverage. They even paid for my cmg. Once you learn how to ask and prescribe for medco it is easier. Remember they are just trying to save money so your sis (probably her employer can afford to have a great drug plan). I never call mine in just do mine over the internet and I get every thing very quickly. Some times things to take a bit.
Jan - I worked for a Pharmacy Benefits Provider (AdvancePCS, which became Caremark, and then became CaremarkCVS). Three of those years were spent as a senior representative - if a customer wanted to talk to a supervisor, they got transferred to us - we would resolve the issue, and get them taken care of.
Can I ask a couple questions - if you don’t want to answer them, that’s fine - but it will help me get something put together here.
If you want, you can answer this through a private message
Who is the insurance provider?
How many times a day is your niece supposed to be testing?
I know you said that you should be able to re-order after 75 percent of the medication is gone - is that the official DUR (Drug Utilization Rate) for the plan? If it’s not in the paperwork, then a service rep should be able to tell you (I say should because I was never really impressed with Medco reps).
Like I said - they’re weird questions, but they’ll help me figure some stuff out. I used to be pretty good at this stuff.
I would have the doctor up the supply so that you have extras just in case the pharmacy does not send the order out on time.
UPDATE ON MEDCO HELL: Finally got a sympathetic Supervisor who actually read the preauthorization number (written on the prescription itself), deduced that under my Sister’s insurance with the preauthorization in place, there is no limitation on quantity of strips. So we got the extra half of the box. Still have not received strips, though, they missed getting strips to the loading dock for Friday’s deadline. I think perhaps they did not have the brand in stock (they denied this but I can think of no other reason for an emergent order to take 13 days total). We will be getting strips Tuesday and will be able to order when 75 percent of our order is finished from now on (also clearly written in her insurance). Now I am used to arguing with insurance companies (such as in order to get coverage for cgms), and Sis is even better at arguing with insurance companies. But I do NOT expect to have to argue with an on-line pharmacy whose job is merely to follow the prescription and fill the order.
Bob: Insurance provider is United Health care. Insurance is excellent. She can test as much as she needs to; there is a preauthorization in place for as many strips as her endo prescribes (won’t tell you the exact amount because I have gotten flamed online before from the “six tests a day and no testing overnight” crowd.) Finally did get a Supervisor that actually knew how to read the prescription and look up her insurance and Supervisor fixed everything; hopefully on the computer so I won’t have to go through this again in three months. Thanks so much for the offer, though, I may take you up on it if this happens again.
Yes, we have this. Number of strips per day, PLUS QUANTITY of boxes of strips PLUS preauthorization number written right on the script. Seems the pharmacist calculated the number of strips from the times per day, i.e., number of strips prescribed X 88 days; figured out that we would be getting forty extra strips more than the # per day (that is why “Quantity of boxes” is also on the script as per Medco’s instructions to us). So, instead of giving us the extra box and 40 extra strips, Pharmacist decided he would SHORT us the 60 strips. No, they would not give us a 50 strip box because doctor’s order said “100 per box.” No, they absolutely would not give us a full box. Now they filled our order properly last time. But this went on for days and days with different Reps. So ridiculous.
My insurance company requires I use medco, and since they made the switch it has been a pain in my arse. The people you talk to on the phone not only cannot understand you but they don’t know any answers to questions either. The company as a whole does not seem to understand the needs of a diabetic. “By the time that insulin gets to my house, I will have been taking no insulin for three days.” “I’m sorry, Miss So and So, but we cannot do anything about it.” It would seem like they need someone there advocating for people with diabetes and other diseases where medications are important and life threatening. It was all much easier when I could just go down the street to the lovely 24 hour Walgreens.
I have a good one for you. If I do an in town prescription I am only allowed to have 3 days worth of medication left before the insurance company will allow me to refill the prescription. If I do a mail in order I am allowed to have a 30 day supply from the time that I did the last order. The fun is when I get a prescribed a new medication and I fill one prescription in town to start it and also do another prescription by mail because I am going to stay on the medication. I have resorted to making sure that I order insulin at the same time as I do a new prescription so that they have had to overnight the prescription to me.
Now, although you will have a hard time getting the Medco Reps to actually follow your insurance’s orders, it can be done. First, see if your insurance allows you to fill the order when 75 percent of the order is used up. The Reps kept insisting we could not. But we could. Called a supervisor and he took the time to look at the script and insurance plan. But the Reps kept insisting they could not fill it. They don’t know what they are doing.
You have to figure out a way to get what you need with Medco. And the amazing thing about it is when the insurance will cover it; but Medco, a Pharmacy, denies it.
I decided to post here rather than start a new thread.
OMG. The company is HORRIBLE. This is my first prescription order with them, so I have to pay the deductible too. From my previous insurance, I’m used to getting one month supplies and not 90 day ones. There is also glucagon in this order, which is so expensive, I guess that’s what’s eating through my deductible. Anyway, I have a mild meltdown when I heard how much my bill was. After TWO hours on the phone between Medco and my insurance, I finally got a rep who insisted on staying on the line with me to call Medco. Finally, I got a rep who could explain the costs and what was going on.
However, I kept getting automated calls from them into the evening. Just a horrible experience. I’ll take care of the order next week (it’s almost double what I expected to pay, so I have to make sure a client pays their invoice before spending.)
But, wow, they simply don’t make it easy for you. I MISS Neighborhood Pharmacy now. They were much easier to work with and explained things very well.
I consider myself extremely lucky. I had Medco through my husband’s insurance, then I switched to my employer’s insurance three months before I retired, and now I can get my prescriptions at my local pharmacy. My main problem with Medco was my insulin arriving warm and being told by Medco that it would be ok to use it. Oh really, a three month supply??
Great. Now I have to worry about warm insulin too? This company sounds horrible. Maybe I’ll rely on them for my pump supplies only and go to a local pharmacy for my insulin. They shouldn’t be able to get away with such crappy service. Neighborhood always sent my insulin from a local office wrapped in ice packs. Because I freelance, I got in the habit of just going to their office and picking it up (it got me out of the house and to another park of town), and my insulin was ALWAYS wrapped up to stay cold.
I know this is late but don’t let anyone criticize you for how many times your daughter tests and when she tests for that matter. Many I know test many times a day just to have the control. No one should criticize you for how many times your daughter tests.
Medco wrapped my insulin in bubble wrap and used a cold pack, not an ice pack, but by the time it arrived the cold pack and the insulin were not cold. It was pretty discouraging to have 6 bottles of Apidra arrive warm.
I had the opposite experience with Medco. My insulin always arrived cold. Caremark on the other hand? I had to threaten a lawsuit to get them to never send it warm again. They were intentionally sending it with not even a cold pack.
I would echo though that the people at the call centers for Medco were complete idiots. Strangely enough I have had pretty good luck with Caremark reps…
Wow, well, as this is my first order, I’ll see how they ship it and go from there. I won’t finalize it until the end of this week, so I won’t get it until next week.
I know that I have the option to go to a pharmacy, so I’ll do that if I end up with a 3 month supply of Humalog that arrives warm.
Good timing for me on this post, MD. I just got a letter from my insurance that as of 1/1/12 we will be switching from Medco to Caremark. The odd thing is I believe it was about 6 years ago we switched from Caremark to Medco.
I’ve had decent experiences with Medco.My insulin always arrived cool. I don’t remember anything one way or the other about my Caremark experience but to tell you the truth, my life experience at this point tells me that all organizations are sometimes great and sometimes…not so much. So I’m not really concerned. Now the fact that they are raising prices on brand name and non-formulary…that doesn’t make me so happy. (Or surprise me too much).