I have always prided myself on being pretty libertarian in my beliefs, but a single experience calling CVS Caremark (our prescription drug insurance) has made me decide to lobby with the Leftists to get the entire industry out of business.
Here’s the back story: wife needed an eye surgery and we ended up going to the big ophthalmology hospital in Ann Arbor. After she was taken into the surgical suite, my job was to go to the pharmacy to pick up the drops we’d need afterward. I understand how prescriptions work (especially at hospital pharmacies) but I didn’t suspect that two little bottles of eye drops (one for dilation and one antibiotic) would be upwards of $60!
I know the pharmacists has no information and I can’t exactly call up the doctor in surgery and ask him to find a different medication, so I pay it and sit down. Since I had some time to wait, the first thing I did was to check the receipt to see what the retail price was versus what I paid (or what the insurance discount was). This is the obvious place to see the breakdown of payment…
… … it’s not on the receipt… The only thing I see is “you pay”.
So the next obvious step is to check my insurance portal for an EOB (like I would any medical procedure). After spending minutes figuring out what my CVS Caremark portal username/password combo was, I finally get logged in and fumble to the list of filled medications (but not ORDERS, those are only for things that are done through the mail order portion #eyeroll).
Apparently prescription drugs don’t have EOBs… The only information on this portal is “amount you paid”… lovely. That’s the information I already have. Even something as simple as showing me which “tier” the drug is in would have been helpful (roughly: generics, brand-name – no generics available, brand name – generic available). So what’s left to do? Call CareMark, I guess. By this time, I’m back with my wife and we’re getting discharged so I’m back on bedside duty and have to drop the issue.
A few days later when we have some post-recovery help from the in-laws, I’m able to take a few minutes to call the insurance company. Here’s how it plays out:
- Call 800 number…
- Automated attendant asks me to describe my issue
- I struggle to summarize my issue and it fails to understand
- After going back and forth a few times, it decides I’m more trouble than I’m worth and says, “Goodbye”; hangs up
- Call 800 number…
- Automated attendant asks me to describe my issue and I listen to some examples
- Decide to prompt it with, “information about an order” (not remembering that “orders” has a different definition to CareMark)
- I fail to give it a correct order number and my account has no orders listed so it says, “Goodbye” and hangs up
- Call 800 number (this is now a Kafka comedy)
- Automated attendant asks me to describe my issue
- I prompt it with things like, “Please! I need help!”, “I don’t know!”, “Speak to a person,” “Human being!” which are all followed by…
- “I’m sorry, but I don’t understand.”
- Finally trigger it with “billing issue” and it says, “Please wait a moment while I get you to a representative,”
- Soon thereafter get a woman with a name like “Kayla” who, within a minute, has understood that I’m asking about whether or not the eye drops are on the formulary and how much of the full price I paid out of pocket
- She tells me one of the drops was tier 1 and had a copay of $4 while the other was tier 3 (brand name not on formulary) and was $56 only because that was lower than the $60 copay that I would otherwise have had to pay
- I thank her profusely, ask her to transfer me to her supervisor so I can compliment her and bash the automated attendant, then do those things (in a voicemail; which is fine by this point)
It’s just amazing to me that this total lack of transparency can even be legal. Or that more people don’t bitch about this. There is a distinct lack of even feigned care as a system and such oppressive opaqueness (that I’ve come to learn is baked into contracts between these Pharmacy benefit managers and the pharmacies) that it’s disgusting!
I genuinely hope the people who built and profit from this modern system of pharmacy middle-manning end up in jail. Unfortunately, with the way American Health Care and our political classes work, the government is more likely to mandate that every citizen participate in a corrupt, rigged industry than to do anything to put them out of business.