Since the 2007 merger of pharmacy retail giant CVS and pharmacy benefit manager (PBM) Caremark, community pharmacists have heard a drumbeat of complaints from patients accusing the combined company of deceptive practices, privacy violations and conduct resulting in higher health care costs. The problems led NCPA, the National Legislative Association on Prescription Drug Prices and the union-backed Change to Win coalition to seek a Federal Trade Commission investigation earlier this year.
Last month, CVS Caremark disclosed that it is currently the subject of an FTC inquiry. That same day, analysts separately expressed renewed skepticism about the viability of the combined PBM-retail pharmacy model.
NCPA recently shared with the FTC the following new, unfortunate patient stories. They are consistent with problems identified in a remarkable Houston TV news report that aired last month. Summarized below, these cases make clearer that these problems are no anomaly and remain a current concern.
Mailed medication arrives late; costly complications ensue; but you “save” $2!
A patient reports having to use CVS Caremark mail order for monthly deliveries of Enbrel, a pain medication. Enbrel must be refrigerated immediately upon receipt.
Despite the patient’s best efforts, including taking time off from work to wait for deliveries, sometimes the deliveries are so late as to result in missed doses. When that happens the bills really start piling up for the patient’s insurance plan: $70 to visit the pain management doctor; $400 to receive a spinal injection and $1,200 for an MRI.
Previously, through the local community pharmacy, the patient paid a $164 co-payment and could conveniently refrigerate the drug. Through CVS Caremark mail order the co-payment is $162. That’s $2 of “savings” in exchange for a stressful monthly ritual, a mountain of medical bills to treat resulting complications and untold hours of lost time and productivity at work. In addition to the obvious health concerns, it’s some “deal” for the patient and taxpayers.
Medicine by Help Desk, part II
This next case is reminiscent of an earlier problem that The Dose covered here – Medicine by Help Desk.
In this case, a resident of a long-term care facility needed a refill from the community pharmacy servicing them, but the claim was rejected. The state requires that the resident’s medications come in unit-dosed blister packaging. When the pharmacist called CVS Caremark to ask why the claim was rejected a phone representative explained that the patient had reached their third refill. Because there were no CVS locations nearby, mail order was suggested. But CVS Caremark mail order did not prepare unit-dose medications.
The phone rep suggested two solutions. Pay out-of-pocket and submit a receipt to get 50% of the cost reimbursed. Or ask the prescribing physician to change the dose of the drug every third refill!
Ultimately, the patient paid cash.
Taxpayers Pay Emergency Room Price for Routine Insulin Dose
After running out of Lantus (insulin), a Medicare Part D patient went to the community pharmacy for a refill. CVS Caremark refused to pay for it, saying the plan limitations were exceeded.
After refusing an override, a company phone rep told the community pharmacist that the patient would need to use mail order. Obviously, that wasn’t an option, so CVS Caremark advised the patient to pay cash to get the drug now.
Because the patient could not afford the $95 out-of-pocket cost, the patient was forced to go to the emergency room to get the insulin in time.
This is just a sampling of the patient complaints that keep rolling in.