Oh, a talking head from Express Scripts

Oh-boy! A response from an Express Scripts Reject!

As an employee of Express Scripts, I just thought I would drop you a line and let you know to fuck off. You pharmacies bitch like shit about this but when there’s drugs out there your being reimbursed SUBSTANTIALLY over cost do you call us and complain? I didn’t think so, not as if any of you fuckers are taking a loss on a day to day basis.

So, a Call Center dropout somehow knows what our cost is to fill prescriptions? What is your definition of “SUBSTANTIALLY” over cost? Is $5 over cost? How do you know how much we get medications for? You think that if we were being reimbursed over a ‘fair’ price we would call and bitch? We call and bitch because:

  • You pay us $7 over the base cost when our fixed cost (salaries, vial, label, etc) is close to $9. But of course you know that better than we do, you work for Express Scripts. Plus we all work for free, the vials grow on trees and label’s are delivered to us by the label fairy. The power company also likes to take IOU’s as well.
  • Your system is down, which grinds our business to a halt, and makes patients pissed at /us/ because /you/ decided to do a system upgrade on the first of the month.
  • You dont print ID cards with the correct and complete information. I shouldn’t have to guess that a person code of 98 is needed to fill Rx’s for your patients. Again, the patients have to wait for us to sit on hold to get the right info to process their Rx’s over something thats /your/ fault.
    So yeah, we call and bitch because there is a reason, we’d rather not spend most of our day sitting on the phone when we could be out filling Rx’s.

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  • 28 Comments

    1. Brian says:

      Every time I call Express Scripts its one pain in the ass after another. They always take forever, and are rude for no reason. I would like to take this opportunity to tell Express Scripts to eat my asshole with a fucking spoon, you cockstains!

    2. Joe the Pittsburgh Intern says:

      Everyone I ever talked to from ESI was a fucking retard. Anyone out there actually get help when calling ESI?

    3. RJS says:

      …and this is why people like this ES person will never be successful small business owners.

    4. Brandon says:

      Have you ever seen those Opus health debit cards/credit cards that take off X amount when they pay for their prescription? Only…they don’t take off that amount beforehand?? They have to pay the co-pay BEFORE the designated amount!!!!
      Way to tell us this…or the other 2 techs there.
      A few days ago, i have a situation, and the lady was like, this should have taken $30 off!! i said well it was run though as a secondary claim. I proceeded to show her the Primary insurance 3 letters, along with the OHS for the opus health thing.
      So she WANTS me to go to rebill/reprocess it.
      I do. BIGGEST MISTAKE OF MY WEEK!
      Fuckin thing sends a reject as a…
      Claim not found, claim already submitted, reversal denied!
      Of course they aren’t open saturday…or sunday! So…
      I call monday at 9am. Seems like you have to CALL them to get authorization FAXED to you to et a REVERSAL out of them.
      I never receive that fax…So when I left at 4, I told my boss that when I come in tomorrow morning, this will be the FIRST thingI work on.
      Came in the next morning, called, and requested a fax to get the claim reveresed. It’s 10:20 am when i call..
      4:25 comes along, STILL NO FAX! Boss asks me to call again, and NOT TO HANG UP until this claim is overriden.
      I tell the Rep on the phone (After waiting 20-30 mins on hold) and tell the lady that i need a reversal form faxed over NOW. This was the 3rd time i’ve called in the past 2 days. She asks me to hold while she went to check the fax machine.
      She comes back, asks if i had received it, i say no.
      She finally decides to do the reversal over the phone (It sounds like their office is having a party anyway!!). Finally get it reversed. she comes in and it is finally taken care of..
      Moral is. OPUS HEALTH SUCKS!

    5. Gravelpit says:

      Hmm…sweet…the computor screen gives me all this nice info…refill too soon, next fill in 7 days…OH, the patient is going on vacation…I’ll call and get a vacation override…after entering all the information via my telephone key-pad…which takes up the first 15 minutes…only to be told by a computor what I already know…Yes the refill is too soon…push 0 for an attedant-15 more minutes on hold…and what’s the first thing they tell you…That the refill is too soon…THANK YOU CAPTAIN OBVIOUS!!!!

    6. vicodinfairy says:

      Yeah, ESI sucks…know who’s worse? MEDCO.

      • Paul says:

        WOW – you must be psycic! The two have just merged, creating the biggest cluster fuck in medical history!

    7. vicodinfairy says:

      Yeah, ESI sucks…how have the never resolved the twin issue? It’s been YEARS people. Still, once you memorize their little numerical override codes you hardly ever have to call them.
      Know who really bites?? MEDCO.

    8. Jason says:

      I had to call Express Scripts yesterday for a prior that i called on a month ago. I had to talk to 3 different people b/c apparently the first 2 didn’t know how to do the override for me, so yeah on the phone for about 45 minutes, but thankfully the patient was actually patient and thanked me about 4 times while he was paying $25, instead of the 110.

    9. Adam says:

      ahh, the sweet smell you can only savor when a fresh can of whoop-ass is opened on some poor fool.

    10. Mike says:

      Tell that fucktard from ES to sit on a barbed-wired wrapped fence post… Then he’ll know what their shitty reimbursements feel like!

    11. The Angry Greek says:

      Speaking as someone at the switch, who has to deal with ESI’s patented brand of dumbfuckery on a daily basis (and I really feel for you pharmacists), I think this is hilarious. These are the same people who tell you to call your vendor or switch when the error message states “for assistance to resolve this claim reject go to expressscripts.com for pharmacists” while their helpdesk employees can’t even find it and stammer on like confused crack-whores. Considering that it’s nothing short of proof that there is no such thing as a just and loving god that ESI continues to /somehow/ stay in business, they really have no reason to be angry at the way someone else runs their business and the things that bother them. Maybe if the things said about them didn’t ring so deeply true, they wouldn’t have afterbirths like this one writing in trying to defend themselves.

    12. Martin S. says:

      oh boy, an esi phone hack feeling sorry for himself. If they had a brain they would have a real job-like prostitute or IRS auditor to fit their personality. I really enjoy hearing from the amazingly ignorant. ESI personel commenting of profitability? The least transparent industry in the US and puppets of big pharma. I guess honest profit is paying the pharmacy $17.00 a hundred for atenolol and charging BC/BS $70.00/hundred. (see congressional testimony MI house of rep). What a bargin, they make 5 times what the pharmacy makes and has no real value added to the process. Gee I wonder how much this butthead has invested in his/her career? this idiot doesn’t seem to get that when they don’t do their job it affects their customers adversely, whom we at the pharmacy are actually trying to help. Something the ESI moron doesn’t seem to get.

    13. Express Scripts "talking head." says:

      Ironically enough I wrote this in an apparent roid-rage outburst (at least that’s what I’m blaming it on.) … or more likley I had just got done having to listen to a bitch fest from a pharmacist about what we reimburse, when we have no particular way to affect what the guys upstairs raking in millions upon millions a year do.
      But come on, Angry Pharmacist, I’ve come to respect and in some odd way admire you due to your blogs, they spice up my day, but to refer to me as a Call center dropout? You know, some of us have to work our way through school, and there are alot worse places I could be working than ESI while I do that.
      Regardless, when you get stuck viewing cost of prescriptions, U&C costs, taxes, etc, as much as I have to on a regular basis you get a rough idea when a pharmacy takes a loss or makes a acceptable profit, and let’s not kid ourselves, there are several drugs out there you guys do indeed rape us on, which is no biggie, independents especially do deserve a bit more reimbursement as it’s harder for them to get customers, but fuck big corpo-chains. In my 2 years at ESI i’ve only received phone calls on 2 or 3 drugs where pharmacies really were taking a hit, and generally our provider relations department (whoever the fuck they are.) re-does the pharmacys’ contract on that drug to be at reasonable reimbursement.
      I realize you guys get pissed off as shit alot of the time at PMB’s like ESI, but it’s not the employees fault for what the select few higher up actually do. Seriously. We agree with you on most points, but you know what? There’s nothing we can fucking do about it.

    14. LordVicodin says:

      I love you. I don’t mean to get mushy, but man if you weren’t a guy, and I wasn’t married I would consider giving your oral. I don’t know how you do it but you consistently rip the thoughts I have out of my head.

    15. Mo says:

      Fucking PBMs…its just a Fucking insult when they throw that measly penny $1 dispensing fee. WHAT THE FUCK..is our GOD DAMN ADVICE only FUCKING worth $1? Thats probably all we are “profiting” off of considering the measly MAC pricing. We all pharmacists should wake up and stop caving into their fucking forced shitty payments..seriously!

    16. indietech says:

      “not kid ourselves, there are several drugs out there you guys do indeed rape us on”
      what? are you kidding me? you’re using this as your excuse? i work in an independently owned pharmacy where we do around 250 scripts every day (not a lot, but decent for a small pharmacy), and i see this happen maybe TWICE a week, three times if we’re super lucky. don’t tell me that’s an excuse to pay us $.50 over on the other 99.99999%.
      you obviously DON’T know your pricing so well.

    17. ghettocist says:

      I find myself, as always wasting my time calling for the reject “plan limit exceeded.” Now usually this means it wont pay for 90 days supply , or 6000 boxes of Lovenox etc.; but when I have an RX for atenolol 50mg daily (#30), then I realize I must make the hell call to Express Scripts so I can watse more of my fucking time. I always get someone like La’Chafonda who has the brain of a shoelace to help. After the usual interrogation, (NABP, NPI, name, DOB, bra size etc…) she tells me that the reject is due to plan limit exceeded. No shit asshole. What the fuck does it mean???? Why is the limit exceeding I ask. As usual she is clueless(oh surprise) and passes me to another representative (usually her cousin La’Quesha), where I must repeat all the same bullshit. She must make an extra 25 cents an hour because lo and behold, she has the correct answer. The reject is because the patient just received atenolol 50mg from another chain 6 days ago. Now I am pissed. I just wasted 15 minutes speaking to 2 dumb fucks because Express Scripts couldn’t have just flashed the rejection “refill too soon.” What the fuck. I hate insurances.

      • ESIer says:

        But it’s not refill too soon. It’s because the plan only allows so many a month. No wonder your name is “Ghettocist.”

    18. cam says:

      I hate insurance companies.
      I especially hate Express Scripts. Their motto should be “let me transfer you to the correct department”.
      What’s more is their subsection for DOD Tricare. Jesus H Christ those cube farm retards are ignorant. I’ve had more luck talking to the idiots in India from Medco than the governmental morons for Tricare DOD at ESI!!!
      I guess it could be worse you know… they could all end up acting like Caremark or Wellcare…

    19. "Talking Head" says:

      You know guys, personally, I find it pretty fucking pathetic you all have to rag on me, one fucking employee at ESI.
      You think you all run your fucking business’ perfect? You think that ANY of the employees at ESI ever have to do shit for patients or doctor’s offices as well? You think when I get a patient bitching at me because THEIR doctors office or pharmacy faxed the PA to the wrong fucking number, and I go out of my way to call said pharmacy/dr office to get shit fixed, that I enjoy that? NO… but you know what? I still do it, without the need to bitch about it constantly like so many people that have posted comments (That was not directed at you, TAP).
      Seriously, I wish I could coast through life thinking that everything I touched turned to fuckin gold like the rest of you fucktards, clearly your shit doesnt’ smell and insurance companies are the lone problem with the world.
      If your an independent pharmacy, like TAP, bitch away, but I doubt every one of you pharmacists or techs posting in this thread IS AN INDEPEDENT, and I’m sure MANY OF YOU work for huge corpo-chain, where reimbursements don’t even fucking affect you hardly, just your COMPANIES bottom line. At least TAP I can understand because what he is reimbursed is DIRECTLY LINKED TO WHAT HE MAKES.
      Bitch away guys, but remember your fucking shit stinks too, and I guarantee you all fuck up just as much as you like to claim everyone else does.

    20. Piss & Vinegar says:

      Hey, I may not be an independent, but the threat of no reimbursement is what’s keeping me out of the business. Why would I want to own a pharmacy when I can work for someone else who has to worry about not getting paid. I didn’t go to school for 7 years to have to worry about losing my business because some dumbass insurance companies don’t want to pay me? Instead, they can line their own billfolds with millions and then cry about not having enough money. Yeah, my shit stinks, real bad. But at least I know how to clean it up without flinging it on someone else!

    21. "Talking Head" says:

      Dear Piss&Vinegar:
      I never said that wasn’t a valid point to a degree. However, you act like we have any control over that sort of thing. That’s the thing that I don’t get, you guys have so much animosity towards people on the other end of the phone, when, I can honestly say, most of the people that work in the call center with me… are just trying to get by.
      They have kids to support, they have lives to lead, sure they may have not made the best choices in life but it hardly is criminal of them, and just because you make more money doesn’t make you any more valuable than them. We all have to co-exist in some way or another.
      You don’t think the rep’s on the phones making $13 a hour have tons of ideas of how to make life easier for both you guys and us? Oh, we do, trust us. But you know what? The talking suits that sit up in our corporate building raking in $500,000+ a year to do no actual work except finding ways to stuff their pockets more DO NOT LISTEN TO US OR CARE WHAT WE SAY.
      We’re powerless, it’s fucked up no doubt, but it’s not as if we are sitting here laughing at you guys for reimbursement rates, half the time we get the same 3-4 questions a day pharmacy line (Date of Birth Error, DUR Rejections, Copay questions, and eligibility question.) So yea, sometimes we are a bit snippy with people, but for the most part we do our best, and would like things to be as easy as possible for YOU.
      You know why? BECAUSE THEN YOU DONT HAVE TO CALL US AND OUR LIVES ARE MUCH EASIER.
      I don’t agree with the way the system is run by any means, but I also don’t know how to get it changed. Just remember, when you call in for DUR Codes, if you have to wait 20 minuets on hold, that means theres 70 people in the qeue because the fucktards known as management didnt want to hire enough reps, and that rep has probaly been given at least as much shit in that day as you have.
      PS: Please write down ESI’s DUR Codes when you call in, so you dont have to call for every single dosage increase, every theraputic duplication, and a drug/drug interaction as small as Potassium/Detrol LA (WTF DOES ESI even flag that as a DD??? There isn’t even a interaction!)

    22. anonymous says:

      I’m just amazed an alleged Express Scripts employee could actually type in correct English. Is it wrong that I read that email in my head with a Punjabi accent?

    23. Janet says:

      I have had nothing but trouble from express scripts. Abysmal. Among the various problems I have had over just the last few months express scripts will not monitor my medication for my gluten allergies that I have. Lovely.

    24. Tricia says:

      I’m just a lowly consumer whose company recently switched to ES for prescription drug coverage and they really do suck ass, I mean hard! I received a letter the other day telling me they won’t be covering my $400 month drug starting in January with no phone # to call but hey have a nice day. Called the 800 # from my card and the front line employees were nice enough but have no power and absolutely will not give out management names. I had one agreeing with me that their practices stink and management needs to be slapped but then she starts pressing me on mail order for my other prescriptions. Aaargh! I just want to talk to someone so I can get some answers as we are in benefit open enrollment right now and whether this drug is covered or not changes dramatically the kind of coverage I’ll choose. Anyone have Barney Gallessio’s number/email? He’s the VP of Member Services that sent me the letter.

    25. Pharmer Ed says:

      I work for a compounding pharmacy and we are in between ESI/Medco contracts. When we call to see if the patient has out of network coverage we get transferred around and then the help desk moron sees in necessary to tell us that we are not contracted with them yet. Really I was not aware of that. Then they tell us that they cannot tell if the patient has out of network coverage. If they cannot then who can, Miss Cleo? If I didn’t know any better I would get the impression that they have a note in their files to futz with us. Question, what is the difference between a zombie and an insurance companies employees? The zombie was once human.

    26. Eric says:

      I work for a company that Express Scripts purchased. Let me tell, this is one of the greediest organizations I have ever been employed with. Health Insurance cost went up with ridiculous copays. on top of that, the affordable plans do not pay 100%. I had to drop coverage just to bring home a decent salary. To make matters worse, they removed several holidays to “put us in line with the rest of the company”. The best part is probably the most ridiculous: they are divesting. Getting rid of us. Why are they going to buy a company, muck it up, then pass on disgruntled employees to a buyer? So I laugh when I hear people say Express Scripts is a great place to work. I wonder how low they set the bar? George Paz was just in the news because his paycheck went up by millions. Must be nice, Mr. Paz. I have no health insurance in a company that revolves around the health care industry. I would be ashamed to call Express Scripts a great place to work. Don’t fool yourselves.

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