Residential Space A creative outlet during residency, turned ongoing virtual soap box

Posted on Friday, March 17th, 2006 at 5:31 pm. About Health Care, Ramblings.

My beef with Andrx Pharmaceuticals, Express-Scripts, and “The System”

Wow, I am fuming mad about another experience. I can only imagine how James would react to something like this were he in my shoes. This is a big one.

So it’s one of those things about being female – taking a little pill each night that A) prevents babies before one is ready for them, B) regulates the cycle thus preventing anemia, and C) keeps the hormones in balance to prevent acne and other un-pleasantries.

Here’s a little background on this situation to better explain why I am so freakin’ mad. Since I began working in June 2005, my new insurance company, Uniform Medical, will only partially reimburse for prescription drugs that are filled through their preferred online/mail-order pharmacy, Express Scripts. In June, I had a great amount of difficulty getting my prescription transferred from my previous insurance company’s mail-order pharmacy to Express Scripts, and then rather than sending me a letter or calling and refusing to fill the order, Express Scripts just didn’t fill it. When I contacted the company, wanting to know where my pills were, they gave me this, “Oh yeah, the nurse practitioner never wrote a DEA number and we can’t fill it without one.” First of all, that is BOLOGNA/BOLONEY – DEA numbers come into play with controlled substances. I never write my DEA number on prescriptions for my patients because I don’t want the wrong person getting ahold of it and forging scripts for their street associates with it – and it has not been a problem. My hospital’s pharmacy encourages residents not to put our DEA numbers on there in order to protect them – if they need it, they call me and I provide it to the pharmacist over the phone. Second of all, Express Scripts never attempted to contact the nurse practitioner who wrote the prescription (whose number was on the script) to ask for the DEA number, and third, they never attempted to let me know that it was not being filled.

Anyway, eventually (let’s call her my “primary care provider”) wrote me a prescription for a year’s supply of birth control pills – Ortho Tricyclen, a popular brand, now available in several generic forms. Physicians can either sign on the line that says “Substitution Permitted” or on the line that says “Fill as Written.” My primary care provider signed on the “Substitution Permitted” line, as I almost always do as well, so that the pharmacy and patient have flexibility should the trade brand cost too much or if the trade brand is unavailable. I sent the script to Express Scripts and received the medication within about two weeks. Instead of sending Ortho Tricyclen (the trade brand), they sent Tri-Previfem, a generic form manufactured by Andrx Pharmaceuticals. Fine. Problem solved. FYI – these pharmacies often send patients a three months’ supply of meds, and expect one to request a refill a few weeks before running out.

Today, I thought – well, I have two weeks left before my pills are gone. Time to reorder. I attempted to reorder on the Express Scripts website, but when I typed in the Rx number, nothing was coming up. So I called the toll-free number, spoke with a phone representative, and she explained that Tri-Previfem was on back order, and that it would be the end of April (at the earliest) that Andrx Pharmaceuticals would be able to provide Express Scripts with an adequate supply of this medication. Fine. So I explained that I would accept any other generic form that could be substituted for Ortho Tricyclen. I’m sorry, said the helpful representative, but your doctor will have to write another prescription and I will have to mail or fax it to Express Scripts. What?! I told her that my doctor had already written a prescription for Ortho Tricyclen, and that it was Express Scripts who filled it with this now-unavailable generic. They told me that (apparently this is a problem with “The System”) once a prescription is filled with ANY MED – be it the trade drug or a generic form – the prescription is only good for that single medication, and nothing else can be substituted later. So even though my prescription was written for Ortho Tricyclen, and Express Scripts and Uniform Medical decided to fill it for Tri-Previfem instead, now the prescription is only good for Tri-Previfem and there is no way to fill it for what the doctor actually prescribed in the first place. I asked the supervisor with whom I eventually spoke why Express Scripts filled my Ortho Tricyclen prescription with a generic form that they could not guarantee I would be able to receive on refill three months later, to which he replied, “Well, you could have a local retail pharmacy call us, and we will be happy to give them the prescription information over the phone.” My response was incredulous: “But you just said the problem was that the drug company cannot provide the medication because the drug is on back-order. That means no one should have it. And if my local pharmacy does have it, not only will I have to pay full price for it because my insurance company demands that I go through you guys, but it also means that the drug is available and that you should have it.”

I swear, this is a totally broken system. What if this was a drug to keep my blood pressure from getting outrageously high, or a blood-thinning medication to keep that second pulmonary embolism from occurring? I hate being forced to use a preferred mail-order pharmacy that provides crappy service, but not easily being able to go elsewhere if I am dissatisfied. I suppose I could always pay full-price at the local pharmacy, but as we all know – medications are expensive, and this is not always feasible. I am so angry that I want to yell at someone, but I don’t know who should face my wrath. The Express Scripts guy eventually agreed to give me a credit on my account with them for the difference between what I will end up paying at the retail pharmacy and what I would have paid with them, so I guess that is a small victory. I think I will next call Andrx Pharmaceuticals to jump on them for over-committing their drug (if this actually turns out to be the case). Then, I am going to figure out why in the hell a prescription cannot be filled for its originally prescribed drug after it has been filled with a generic. That is just plain dumb. If I find this is a federal law, then I might have to go on a Shawshank Redemption letter-writing campaign – you know, where Andy DuFresne wrote a letter a week asking for funds for the prison library until the powers-that-be got sick of him and gave him what he wanted. And if that doesn’t work, well – I’ll probably be a mother by that time.


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