By MATTHEW HOLT
Today we will have fun with show and tell. I want to show you how a little corner of American health care makes my life as a consumer worse and more expensive. I hope someone can tell me why.
Cast members it is: me, my MD, the (former) independent pharmacy that delivers, Alto, and the insurance company Blue Shield of California and the PBM CVS Caremark, which also owns the mail order pharmacy.
Brief background: For years my doctor complained about high cholesterol, and a few years ago I was on a statin called Rosuvastatin Calcium. Older readers may remember Jean Luc Picard himself advertising a branded version of Crestor, but it has been off the patent for about a decade. About 50 million Americans now take statins, almost all of them in general, including many 60-year-old men like me. Cholesterol is coming down, but the MD said it could go down more, so a few months ago we increased the dose to 40mg from 20mg.
Until recently I was insured by BCBS Massachusetts, and you may remember over a year ago I wrote a piece on THCB about the fun and games it would take to find out what the PBM (CVS Caremark) was doing with the price of my son’s ADHD medication. But they never interfered with my meds because my statins were cheap. At least I thought they were. In fact, as recently as April last year, they were free. You can see the price of delivery from Alto Pharmacy below.
How BCBS Massa came up with $ 0.00 as the price I paid I don’t know, but maybe they think it’s good to have me on statins in the hope that I don’t have an (expensive) heart attack instead.
Then for some reason, the price of statins that same year went up to $23. No longer $0 but at $8 a month it’s not really worth making a fuss about.
At the end of the year, COBRA expired and I went to buy insurance on the California exchange. And in order to access my family doctor at One Medical, I chose the only plan, Blue Shield of California HMO.
The next 90-day supply is the first to go from 20mg to 40mg, but it’s still common. Blue Shield of California also uses CVS Caremark (although it has talked a good game of ditching CVS Caremark and setting up its own PBM) and the cost at Alto is barely budged. It’s now $28.
What happened next: So everything was normal until the end of last week when the next supply of 90 was delivered. Except it’s not. Alto delivers a 30-day supply and charges $19.
Also, why exchange a 90 day supply for a med that is supposed to be taken every day for 30 days?
I asked the Alto message system and they blamed Blue Shield.
And of course Alto is now only allowed to fill other drugs on a 30 day cycle.
So basically it looks like Blue Shield’s mail order service is playing hardball. They want me to transfer the 90 day order to them.
A diversion: Before I do that, it’s worth looking at what it costs for cash. GoodRx’s lowest rate is about $18 for a 90-day supply. But of course I have to drive to pick it up, when Alto delivers. I will pay $10 more every 3 months for it.
Enjoy our customer service: So now to serve our good THCB readers and because I’m thinking about the consumer experience, I decided to find out from Blue Shield what’s going on. (I also live tweeted fun and games)
“I’m with you @BlueShieldCA continue the music. Let’s see how it compares to South Park….” (I’m sure you’ve seen the South Park version by now)
The answer is not good. BCBS Mass has a chat function, if not AI. Blue Shield of California has a phone line. With voice recognition that, well, can’t.
After they asked me my date of birth and made me believe my sixty is fifty. It is also clear that the voice recognition can not understand “NO” but they are so confident that it is perfect they do not let me “Press 1 for yes or 2 for no”. But he was happy to tell me that the benefits details are not a guarantee of payment & I need to schedule a health visit–even though he knows my phone number and he has paid for health visits this calendar year. There was over three minutes of irrelevant messaging, then 90 seconds of further identification that didn’t work because it still couldn’t determine my year of birth.
Blue Shield technology leader: In a public statement, Blue Shield demanded that it update the technology. In fact Exec VP Peter Long has bragged about it on Linkedin
Regular tweet readers may remember him earlier this year sending the same 5 letters to tell me I had changed PCP, which I mentioned first!
You might guess that I don’t see tech upgrades as improving my experience…yet.
So back to the statins. You will remember that it seems that Blue Shield changed the maintenance statin I have received from Alto Pharmacy for 30 days without telling me, and without allowing Alto to charge for 90 days. Presumably they want to move this to PBM/pharmacy for profit.
The cost for 90 days is $28, for 30 days $19. So if I stick with the Alto, my annual costs will be around $112 to $228. So if I do nothing, someone will save an extra $116.
You may remember that I was arrested. An agent came to the last line and told me that I should speak to the pharmacy. After being on the phone for 22 mins, someone came and the opening words were to tell me that Blue Shield, “not us”, insisting that I get this medicine through mail order. So who is “you” I ask? “CVS Caremark” they say. So “how do I get an Rx through CVS Caremark” I ask? You can do it on the Blue Shield site. And if you hunt around a bit you can.
So I simply clicked on the Blue Shield site, went to the CVS Caremark sub-site for Blue Shield, registered with my ID number on the CVS Caremark site and got this:
This has taken me 26 minutes on the phone, (not counting the first 5 minutes the phone dropped), 10 minutes screwing around in @blueshield & @CVSHealth site, and of course the two sites could not communicate…and they asked me to call back.
But because I’m a bastard for punishment I tried again, and saw that I could figure out some other ways on the Blue Shield site. That’s where I found the drug pricing tool.
I would like to know the cost to switch to CVS Mail order. The tool knows the drugs I want! I asked the price of the statin and was told it was $19 for a 30 day supply – every price Alto charges. It also tells me I can get 90 days via mail order!
So I clicked on that link and it’s now sent to @cvspharmacy (again), which allows me to click on the new Rx I have filled (I think based on the statement from February) to see what the price is via mail order.
And of course you can guess what the response is.
The answer is that a 90-day supply is not available in stores and there is no 90-day supply through mail order. And for this good experience, they want to stop using Alto Pharmacy. Maybe they want me to force the doctor’s office to send the Rx back to CVS mail order.
If you still keep the score, somewhere between Blue Shield and CVS Caremark, for the maintenance drug that they want to encourage me to be in (I assume), which costs almost nothing to acquire, they want me to change the pharmacy and / or disturb my doctor
We still won’t know if it works, and it’s not sure who asked for an extra $116 if I went back to 30 days in Alto.
And of course it would have been easier and cheaper if I had paid the $11 + shipping it would have cost me to buy 90 days of Mark Cuban’s Cost Plus medicine. But then it won’t count as a deductible, and the insurance company, which is supposed to take care of my health and Rx adherence, won’t know what meds I’m on.
I hope you’ve enjoyed this little trip through this obscure corner of the American health care system. Bonus points if you can explain why anyone would want to go through this, or what Blue Shield or CVS Caremark got to make me do it.
