My Mail Order Prescription Nightmare

I am no longer surprised by the delays and lack of common sense from those who send me diabetes supplies. Really, it's become an expectation that chaos and frustration are par for the course every time I try to fill a prescription by mail order.

My latest mail order nightmare involves the notorious Express Scripts, the third-party benefits manager that my insurer Anthem BCBS requires me to go through. Thanks to a busy work schedule and travel last fall, I overlooked my calendar reminder in November and was late trying to refill my Rx for test strips just before the holidays rang in.

It ended up taking 31 days from start to finish to get the strips I so desperately needed, and today I'm going to tell you the story of how that went down.

Let me start by noting that I'm no stranger to the steps required for these types of prescription fills. I've been at this a while. It's no secret that you have to always jump through hoops like obtaining doctor sign-off for Amount Overrides, Medical Necessity, Prior Authorization, not to mention customer service and billing issues.

But somehow Express Scripts makes it even more complicated, with added bonus requirements (that bring either chuckles, tears, or hand-wringing depending on your mood and how long you've been at this):

• Confirmations That You Are Who You Say You Are - even after they've asked you three times or more.
• Re-Entering Information - likewise, never assume that just because you've told someone on their phone line a piece of information and confirmed it, that it will be recorded in their system.
• The Need to Navigate Call Transfers - since you can never reach anyone short of a supervisor who can look at the screen with your all information to give you straight answers.
• Misleading Customer Service Reps - who do not always leave notes in your file, as they
  tell you they will.
• Blaming Your Doctor - even if your doctor tells you (s)he has phoned Express Scripts and the Insurance Company about something, and provided documentation attesting to this, Express Scripts often seems to insist that delays are the doctor's fault for not submitting necessary forms.
• Getting Cut Off - even if you do manage to speak with a supervisor, if you happen to drive through a tunnel or the squirrels hang up the phone as they often do, don't expect to re-connect with that particular individual again. You'll likely have to explain the whole story anew, to someone else. Because it's a policy that the reps can't see who previously had your account records open unless that person leaves their ID in the system (and they mostly don't, of course -- who wants to take responsibility?)

Once upon a time, I thought it was just bad luck that these delays and problems kept happening to me. But thanks to the wonders of the Diabetes Online Community (and those outside the D-world), it's become much more clear that these are institutional issues and the system is set up to operate this way.

Why?

I can't help feeling it's because they just want you to give up, to stop fighting and to eventually accept whatever they're offering without quarrel, or just go away completely and stop asking for things.

That's certainly how I felt during this latest round of Express Scripts struggles.

My Christmas Ordeal

I called in a test strips refill on Saturday, Dec. 13, but unfortunately didn't realize that it was a calendar-year prescription from my former endo. I needed a new one, so I called first thing Monday morning to inform Express Scripts of my doctor change so they could contact the correct physician. All seemed OK.

Four days later, I received a call saying they needed my doctor information because the former endo wasn't filling the order for me. What? I asked the person to simply read back through the account notes from earlier in the week, and after she did that, it became clear someone messed up. I was told this would be resolved immediately.

The next day, a Saturday, I received a phone call while out at Starbucks. The man on the other end told me they couldn't reach the new endo, because apparently they didn't have a correct phone number. I asked the Express Scripts rep if he had an Internet connection in front of him, and when he said yes, I challenged him to look up the doctor's information while I did the same to see who could find the number first (hint: I won).

Long story short, it was now approaching Christmas and I assumed I wouldn't be seeing any test strips show up before the holiday or year's end. Of course I placed numerous phone calls to follow up with my insurer and doctor to confirm they were doing what was needed, but on the Express Scripts side, I'm convinced it sat on someone's desk through the holidays and then was transferred to the "Archives"... meaning the order was put on indefinite hold.

After the first of the year, two different supervisors blamed the delays on my doctor not following protocol or my insurer not issuing Prior Authorization, even though I know neither was true. At one point, my helpful Anthem rep (really, she was!) tried to press Express Scripts to explain what they still needed to process my refill. They told her more "clinical info" was necessary alongside the number of tests per day, brand, and Medical Necessity form. We're 99% sure we provided all that -- but no one could apparently relay what specifically was missing.

Through all of this, I tweeted from my personal Twitter account, pinging @ExpressScripts on these not-so-positive messages about the apparent stupidity of their system.

Ah, once I started tweeting and publicly shaming Express Scripts (and I also phoned the corporate office), my request seemed to magically go through! But only after another week-long delay, which an ES supervisor told me is automatic, as all orders require a week for processing by design. The supervisor couldn't tell me why a whole week was needed, although I could pay an additional $25 to have the order expedited. WTF?

All in all, I spoke with 12 different people to get this order filled, not counting the few at Anthem and my doctor's office. Total time on the phone: More than two hours, or 120 minutes, spread out over four weeks. Remember, this was for just ONE prescription refill, of the hundreds I've needed in my 30+ years with diabetes, not to metion all those I have to look forward to.

And although this particular refill request was submitted in December 2014, Express Scripts failed to get the prior authorization until the new year, so my deductible reset, forcing me to pay nearly $200 for my three-month order of strips; before Dec. 31, it would've been $0.

(Cue my pocketbook frustration!!)

Systematic problems?

I'm not the only one to complain about this process, and the problems are certainly not restricted to Express Scripts. In doing some exploring online, it's simply amazing to see how consistent the customer complaints are. Many folks are also complaining about being forced to use Express Scripts, when they feel a different mail order provider might serve them better.

A Google search for "Express Scripts complaints" brings up pages of grievances from patients and end-users like me, with the leading result at Consumer Affairs titled, "Top 1075 Complaints and Reviews About ExpressScripts." Ouch! If those are just the top 1,000+ complaints, who know how many there actually are?

What can we do? Well, it seems like the first step is staying committed to the phone fight, and then using resources like social media to call them out if necessary. Check out this great post from D-advocate Christel Aprigliano that offers a great list ofthings to do if you’re having a problem with your health insurance company (top suggestion: document everything!), as well as D-blogger Scott Strumello's recent post titled, "When All Else Fails, Call the CEO's Office at Your Insurance Company" (worked for me!)

I bet many of you are wrangling with these prescription problems at this very moment given that it's January. Care to share your method of coping or fighting back?

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Originally published at DiabetesMine on Jan. 27, 2015