The price of free

There is an inherit problem with having zero copays for our “less fortunate” friends.  Lets look at two cases.

Mary is a 35 year old single working mom.  Her ‘baby daddy’ left her high and dry when the going got tough.  By using daycare through her family, she is able to pull off a part time job and qualifies only for food stamps.  She is not eligible for full-scope welfare due to the inherit racism that goes on within the welfare system (yeah, I went there, ignoring it wont make it go away).  She forgoes the fancy cell-phone, cable-tv, and nice car to afford health insurance for her and her baby (which shes fine with, she views insurance as a necessary expense like food).  Her copays are $50/rx.

Jacob is a 45 year old male.  Due to heavy cocaine use during his youth he has congestive heart failure and as a result is unable to work (according to him and his quack doctor).  He recieves full-scope welfare complete with food-stamps and a check every month.  He spends his day harassing his pharmacy about refilling his pain-pills early and enjoys watching daytime TV.  His copay is $0/rx.

Both Mary and Jacob bring you an Rx for some Flovent.  Mary pays $50 and Jacob pays $0 for the same Rx.  Both leave your store drugs in hand.

A week later, Jacob calls you and says he lost his Flovent.  He has spend a whole 4 min’s looking for it and demands he gets a replacement at once.  Mary also calls you a week later.  She has torn her entire house apart looking for this Flovent and is reluctant to ask for a replacement Flovent at the cost of about $175.  Jacob is upset at YOU that the insurance wont pay for it early, and Mary is upset at HERSELF for losing something that cost her $50.

See where this is going?

There is a HUGE problem with giving people medications for free.  The problem is that once something is free, people see no value to it.  Sure Jacob lost a Flovent or Blood Glucose Monitor, but because to him its free, why should he spend any of his valuable time to actually look for it vs just calling and getting another one for free.  Mary has an incentive to tear her house apart (or call her insurance company) looking for the lost Flovent because it COST her $50.  Jacob is out nothing, and Mary is out something.  Jacob gets everything handed to him while Mary busts her ass.  Both are “in need”, but their reasons for being “in need” is another rant for another day.

Mary obviously places a value on her Rx’s.  Even if shes oblivious to the true cost of the medications (and how much her insurance company pays), shes quite aware to HER cost for those medications.  Jacob, on the other hand couldn’t care less how much his lost medication has cost the state because HIS cost is a whopping zero.  Who cares if he lost every medication on his profile in an act that was entirely his fault, he’s out nothing short of the inconvenience of driving to the pharmacy and picking them up again.  He wont have to choose medication or rent, and his check wont be impacted in the least.  Mary isn’t so lucky.

Lets put it this way; by getting drugs for $0, there is no negative-feedback/punishment/repercussions for losing medication.  Medication has a net-worth of $0 to them, and they don’t give two fucks what happens to their medication because their lives are not financially impacted by losing them.  If I spend $50 on something, and I misplace it, I’m sure a shit going to tear everything apart looking for it.  Is it the same if I spend $0 on something?

Think of this next time you fill that ER prescription for Tylenol and Robatussin DM.

HealthNet & CVS/Caremark – Screwing the pooch for 2010!

Sorry for the lack of updates.  Between vacation, work/life, and lack of good and funny rants things have been sorta slow here.  I intend to fix that for 2010. One rant twice monthly if it kills me.  Too many posts don’t get the awesome comments, and too little makes people lose interest in the site.  Twice a month is a happy medium.

On with the rant!

As you all well have known, we are in 2010 and we are one week past the dreaded first of the year mayhem.  If you are a pharmacist, and have not died from alcohol induced liver failure you obviously have first hand experience about HealthNet (Or their processor, CVS/Caremark) screwing up SO bad that I can’t even believe that they are still in business.

For those not “in the know”, lets set a few things straight so people don’t get confused.

  • You have Medicare + Medicaid
    • You have no deductible (of usually $250 – $300 depending on plan)
    • You have little to no premiums
    • No doughnut holes (ie: the coverage gap)

Pretty much if you are on the state tit because you cannot take care of yourself, you get all the benefits of a Medicare part D plan without the annoying doughnut hole, deductibles, and screaming high copay tiers.  Nice isn’t it?  The rest of us however have the initial deductible, blah blah blah.

Now, lets rewind to HealthNet’s Medicare part D plan oh, a week ago.  At least in California, NONE of the “Dual Eligibles” (the people with Medicare AND a state welfare insurance) were flagged in HealthNet’s computer system as being on a state welfare program.  Which means that almost all of the people who should of had NO deductible suddenly got one (with a $200 copay for their Advair)!  Compound this with the usual first of the year plan changing clusterfuck and you have yourself a 2 hour hold time with HealthNets pharmacy help desk!

Oh, lets not forget that HealthNet also didnt flag generic Vicodin and Septra DS as being covered items.  So for one insurance company, we have a shitpot full of welfare-recipients pissed off at us because “we” want to charge them more than $1.10 or $3.20 AND their vicodin is no longer covered.  So whats a pharmacist to do?

Easy.  Let the fucking patient get off of their asses and take care of it themselves.  Why should we have to suffer the fallout because some computer idiot over at CVS/Caremark (which I wonder if CVS pharmacies had this problem) totally fucked up the data import from California MediCal.  Yeah, I’m a heartless asshole but I’m tired of being the human fucking shield for these PBM’s who make more per prescription than I do.  What happened with HealthNet was completely unacceptable and embarrassing.  Of course HealthNet/CVS/Caremark will continue to collect their fat ass subsidization checks from California as they tinkle in our faces with their whopping $3 above cost reimbursement.  Here me now HealthNet, unless I see some MAJOR lawsuits from you to CVS/Caremark over this bullshit, I will do everything in my power to switch my Dual Eligible patients to any plan that is not administered by you.

Oh, and just icing on the cake, I got the fax yesterday evening from HealthNet that everything was fixed.  Thats 8 days of chaos due to  a company that makes more in 1 week than I’ll see in 10 years.

Post your hateful HealthNet comments (or funny first of the year stories) and lets see if I get a response from them (and hopefully not a C&D letter).