UPDATE: As of Sunday morning, December 30, a pharmacist at the local CVS has taken it on to provide a sensible solution. I’d rather not discuss details until it’s fait accompli, but it’s fair to us, I don’t have to short my shots, and I’m happy with it. ~ NanuqFC
Not only is IBM sticking it to their current employees, with the latest pronouncement on annual payments into the 401k accounts that have replaced defined benefit pensions (as opposed to the previous practice of paying in each pay-period). The company is contracting with a health care/prescription provider that is sticking it to their retirees. My spouse worked for IBM for 32 years.
I use insulin of a particular kind that is not available as a generic. A couple of days ago, I ordered my usual refill, a three-month supply through the nearest CVS pharmacy (almost an hour’s drive from our house), which handles the IBM accounts. Yesterday my spouse went to pick it up. Instead of the usual $70 for that amount of insulin, the cost to us was $353.57. I was out of cell phone range. My spouse did not want me to be without a necessary drug, and she put the cost on plastic, having been assured by the pharmacy tech that the drugs could be returned, if not used, and the cost refunded.
That turned out to be a lie – or at best, total misinformation.
I called IBM member services to complain about the outrageous price hike. That phonedrone called CVS. Together they told me that we had “met” our annual maximum of $2500, and therefore had to pay full price for the insulin. I asked what options there were, and unless there’s some higher math going on here that I don’t know about, the CVS rep then lied about the cost of a single vial (there are usually 5 in an order), telling me it would be $139 (but now, not on the phone and with calculator in hand, I can see that $353.57 divided by 5 = $70.71).
“Okay?” the CVS woman said. “No,” said I. “It’s never ‘okay’ to deprive people of necessary drugs for money. But, yes, we’re done.”
Then I called the store, and “Dan” got on the phone at the pharmacy. I explained the situation, and that I had kept the prescription in the bag, hadn’t opened the bag, still stapled with the receipt, whole thing in the fridge, did I need to go there today (at just after 5 pm) or could the prescription be returned tomorrow?
That elicited an “Umm, let me ask the pharmacist about that.” He came back with, “Sorry, it’s not returnable. It’s both state law and pharmacy policy that we cannot accept any returned prescription once it has left the store.” He was polite and even somewhat empathetic (I’m sure they’re not paying him enough for dealing with polite but irate customers like me). “I don’t know who told you that it would be returnable, but it’s not.”
One more try: “So CVS makes a ton of money ripping off IBM customers, and I’m left with a huge hole in my budget that I can’t afford.” Dan: “I know, I understand that’s what it looks like, and I’m sorry, but there’s not really anything we can do.”
So, did we have any inkling that we had “met” our maximum benefit and that I should’ve waited two weeks before ordering a refill? Not really. We got a statement in July and there was at least $1000 left. Most of my scripts are generic, i.e., cheap. They don’t cost much. There was no reason to suspect that we’d be SOL before the end of the year – it had never happened before. Could I have waited two more weeks? It would have shaved things mighty close. Maybe if I deducted a couple of units from each shot, I could have made it over the finish line. And I could’ve confined my consumption to protein and water to try to keep my blood sugars in check. But I would’ve had to know before my spouse went to the pharmacy that we’d maxed out.
Ya think maybe CVS, which handles IBM prescription ‘benefits,’ might have had a (moral, if not legal) responsibility to inform the subscriber that their benefits had just run out for the year? Or that the people behind the counter should have been able to tell my spouse why the price was so unexpectedly high? Or at least not lied about being able to return it?
Spouse has been looking (at my outraged behest) for an avenue of complaint. I think IBM should at least pretend to care in public about the lousy job its contractors are doing administering its self-insurance benefits. Maybe it’s “Welcome to the ‘new’ nimble IBM: we don’t care who we fuck over.”
Moral of the story: This is what corporado-run health care looks like, even with relatively “good” benefits from a major corporation. One of those corporations running healthcare might end up being the State of Vermont, Inc., if Shummy’s prediction comes true about costs going up for the poorest Vermonters under the new “universal access plan” when it replaces Catamount Health and VHAP.
In my fantasy, I’m walking the sidewalk in front of CVS, carrying a sign: “I’ve been SCROOGED by CVS: IBMers Beware!”
The Invisible Hand of the Free Market has decided that it is better that you die a horrible painful death, than for IBM, CVS or the insurance company to lose one penny in profits.
Let the Free Market decide! It is ALWAYS right!
It never did.
While Vermonters still served to reinforce the company’s bottom line, it managed to look like it cared because that is the “etiquette” required for business PR. Sort of like every male politician is supposed to be a “family man.”
This is what we can all look forward to in a future where union power has been successfully reduced to dust by unrestrained “free” market capitalists buying elections and divvying up the spoils.
From the CVS Caremark website:
From the CVS page on Wikipedia:
That said, prescription switching was not the problem here. Such a history suggests, however, that the company has no particular commitment to ethical behavior, no matter what smarmy platitudes they’ve got on their public portal. And the local lack of ethical behavior (lying to my wife about the returnability of the prescription) as well as the lack of PBM “management” of our benefits to “save time and money on refills” by alerting us to the approaching maximum are definitely part of the problem.
NanuqFC
The decadent international but individualistic capitalism in the hands of which we found ourselves after the war is not a success. It is not intelligent. It is not beautiful. It is not just. It is not virtuous. And it doesn’t deliver the goods. ~ John Maynard Keynes (1933)
I called the pharmacy on Saturday morning to complain about the misinformation we were given (that the package could be returned). The pharmacist, Pete, was terse (he was the only pharmacist on that day, he said), but polite. He said he’d have to take it up with his manager and he’d get back to me.
He called me around 9:30 a.m. Sunday, and said it would have to be considered by the district manager, since they’d have to eat the cost. I stressed that we live frugally on retirement, had never met the maximum benefit before, and would have made different a different decision if we had accurate information. No timetable was offered (and I didn’t think to ask).
It seems to me that the best solution would be to rebill the insurance company on January 1, refund the difference to my wife’s credit card, and I keep the insulin. Less waste all around.
The message I get from these phone calls is that at least someone is taking it seriously that CVS has some culpability here. I’ll let you know what happens.
NanuqFC
The time is always right to do the right thing. ~ Martin Luther King, Jr.
It’s not easy to find ways to provide the kind of caring service that small pharmacies used to provide.
As retailers get bigger and more global, they give less and less back to the community in the way of individual attention; so the individual pharmacist is greatly challenged sometimes to find a way to help.