Category Archives: Medicare Part D

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).

Medicare Part D – D-Day all over again.

No no, I’m not going to give our dear friend Ken a good beat-down like some of you have been hoping.  I’ll get my revenge when he asks for his Vicodin and Soma a week early and his doctor and I (in some “fuck fuck paternalistic plot fuck fuck” tell him to go “paternally fuck” himself).  Besides, you all have shown him the errors of his life way better than I could.  Seriously, 50 comments and counting wasting this douche bag surprised the hell out of me.

Before I start bitching about old people and Medicare part D, I would like to bring to light the best comment I think I have ever received.

All you people who think TAP is so funny and so smart. You know who you
are. The ones who come here daily and encourage him and his behavior.
Will you still be proud of yourself when this human time bomb goes to
work one day and shoots up a group of innocent people? There is no one
more psycho and disgruntled than TAP. You people couldn’t care less
about him. If you did you would try to help him with his displaced
anger, instead of being the enablers that you are. I hope when you read
about him in the newspaper one day, you take your share of the guilt.

Wait, are you saying that there is nobody on this earth more psycho and disgruntled than me?  Oh how my heart flutters with bile and hatred!  Take that Angriest Pharmacist and DrugMonkey!  Have you gotten a comment saying that you’re a time bomb? Have you gotten anything that predicts you murdering a bunch of innocent people?  No!  Me – 1 and You – 0!  But realistically, “try to help him with his displaced anger”? Give me a break.  This isn’t a self-help group therapy site!  Lets all sit around the ScriptPro and sing songs of peace.  Obviously Marcia W, poster of the comment above, needs a big helping of the clue-bat to realize what kind of site this is.  Of course she agrees with Ken, so shes probably with Ken asking if he can get his narcs early if she pays for them with a two-party check.

Anyway, since this isn’t the Ken and Marcia show, and all of you “enablers” out there (50+ comments and counting!) are about to get fucked over on the first of this year, lets get back to the task at hand.

I have an idea.  Lets take a insurance plan and make it as complicated as possible.  Lets add shit like deductibles, a coverage gap (aka: doughnut hole), catastrophic coverage, multi-tiered copay systems, the works.  Now lets force the one class of people who have the least amount of understanding: The Old.  Now lets pawn the explanation of everything to our local pharmacist who we will pay $2.00 above cost for this service.  Lets send out ID cards with the wrong information on them as well send deceptive ads and salesmen around to complicate and confuse things even more.

That boys and girls, is Medicare Part D, and its the utter-clusterfuck of pharmacy.  They have made the absolute complex insurance plan possible and forced the old and stupid to use it.  Lets face it, the 65+ crowd aren’t the sharpest crayons in the box and are the most willing to bitch and moan.

On the first of the new year, retail pharmacy as a collective will either stick the proverbial shotgun in their mouths and pull the trigger, or will drink themselves into oblivion.  On the first is when all of the deductibles reset (and yes, you WILL have to explain what a deductible is to the same patient for the nth time in a row), plans merge, shuffle around, Argus and Wellpoint go down, etc.  Its going to be a mess.

However seniors, being old and confusable, forget about a few years ago when there was no Medicare Part D and they had to PAY OUT OF POCKET FOR EVERYTHING minus that measly discount the Medicare card gave them.  How quickly they bitch about $3.10 COMPLETELY FORGETTING they were paying $65 just a few years ago.  “I’m old and I deserve something.”  Yeah, well I’m not old, you’re using up the Medicare money that I put in but will never see, and I hope your little electric scooter shorts out in the parking lot so I can laugh at you.  You would think they would learn the routine now that Medicare part D has been out for 4? 5? years.  Yeah, you would think.

I’ve said it before and I’ll say it again, that Medicare Part D is a mean and cruel joke on the old and stupid and revenge on pharmacists.

I’m dreading the first

Fixed Income Medicare Blues

I know I haven’t been posting lately compared to my DrugMonkey and Angriest counterparts.  Don’t feel like getting into politics here and I dont like to rehash stuff (too much).  Had to reprime the angry-reserves. 🙂

People always sing to me the ‘I’m on a fixed income” blues when they are paying their Medicare Part-D $3.10 copays for their $200 Nexium Rx.  Oh, how soon these idiots forget what life was like before Medicare Part-D took effect.  Did they somehow forget paying full price out of pocket for their medications?  Why is now $3.10 so much of a financial drain on their “fixed income” when just 4 years ago they were paying 10x that amount with a smile on their face.  I really do get a huge hard-on when I bring up how much they were paying before Part-D and how they are only paying $3.10 (which makes them feel like huge ungrateful douches).

Medicare Part D has spoiled seniors, plain and simple.  They are so hung up on their “fixed income” that they have completely lost sight that the people who are footing the bill for their expensive medications are the same people who will never ever see a dime of the money that they contributed to the system.  They also fail to see how Medicare is pretty much socialized medicine for people over 65, and we can see how well THATS going.  Medicare recipients complaining how we should have socialized medicine in this country just makes my irony meter fly off of the chart.

What do you expect from old people other than cow eyes, the same question asked every week, and bitching about $3.10 copays.

HIPAA Primer for BravoRx

Dear BravoRx,

Please get your collective heads out of your asses and research what is and is-not information that is protected by HIPAA.  Today I had to spend 20 min on the phone yelling at one of your representative because they would not give me the birth date they had on file (which was wrong) because they said it was a HIPAA violation.   Because your company sucks and you are lazy, I will spell it out for you.

If I fill Rx’ for a patient, I fall under “patient care” therefore no medical information can be withheld from me in the name of HIPAA.  Go look it up.

Here, I’ll do it for you:

Yes. The pharmacist is using the protected health information for
treatment purposes, and the HIPAA Privacy Rule does not require covered
entities to obtain an individual’s consent prior to using or disclosing
protected health information about him or her for treatment, payment,
or health care operations.

See that? FOR TREATMENT PURPOSES.  However this clause does not apply because a birthdate is not MEDICAL INFORMATION!!!  Its a fucking birthdate! Get your head out of your ass!  Its not a SS# but something that is pubically available!

So thank you BravoRx Rep, for wasting my time with your shitty substandard service and lousy reimbursement rates.

May the pox of Argus be upon thee,


Medicare Part D – 1/1/2008

Did it go smoothly? No.  Was it a complete clusterfuck? Yes.  Am I suprised? No.

Today was a diaster.  I had some insurance companies publish the completely wrong information on the cards, bunch of stuff that isnt formulary, “card? what new card?”, and a shitpot full of people whom a deductible = rocket science.  Lets not even get into how fun it was to try to get through to any helpdesk.  The only shining moment is that Argus did not go down, and to be honest most of the big processors were not down for any length of time.  They had 3 years to figure this shit out, good job boys.

Yes, please bitch at me a bunch because you have a $0.05 increase in your copay for your $100 medication.  Plus, just to show how much fate hates TAP, it made one of my printers blow up today, and our pharmacy software glitch like mad.  Wonderful.

I barely have the ambition after a good night of drinking Jack Daniels to even write more.  I’m just so happy that today is over.

Medicare Part D – Mexican Food and NPI

First off, Merry Xmas to everyone.

The 1st is looming closer and closer.  For those in you not in pharmacy, the best way I can describe the feeling is as such.

You just ate at this Mexican food restaurant.  The food was good, but you have this feeling in the back of your mind that you will be spending the evening peeing out of your butt.  However you aren’t 100% sure that you’re gonna expode out of your backside, you’re just 98% sure.

Thats how we feel right now.  I’m about 98% sure this is going to be total clusterfuck, but there is a small hint in the back of my head that it might be okay.

Now something that complicates this whole clusterfuck even more: The dreaded NPI number.

How many doctors have you gotten an NPI number from?  How many insurance companies are going to ‘suddenly’ require an NPI number on 1/1/08 without any prior warning or notice?  How many doctors have you asked “Hey, whats your NPI number?” only to get a “Whats an NPI number?” answer?

For Xmas, all I want is a 5th of good scotch, a few cigars, a box of fentanyl patches and a well-heated hot tub.

Medicare Part D 2008 – Please Not Again

Does anyone but me have this feeling of impending doom about the first of the year?  For those not in the know, a whole bunch of Medicare Part D plans are changing/merging/switching/etc as of the first of the year.  I know that HealthNet (I think its HeathNet) is switching processors, and there are about 4 or 5 new plans to replace the 4 or 5 that are going away.  People are getting switched around, new cards issued which means new ID/Group numbers (if they have the card AND its printed correctly).

It’s going to be hell all over again.  New cards, down systems (*ahem*Argus*ahem*), confusion, copay changes, formulary changes, hour long help-line hold times, everything hitting us all at once.  The Medicaid/Medicare people are getting auto-switched into new plans, there are confusing letters flying all over the place along with salesmen who will promise golden turds to any senior who will sign on the dotted line.  Add onto that a system that is horribly complex and confusing thats targeted at the population segment that is confused by the most simplest things.  Breaking out the booze yet? 🙂

I hope after the first I quote this post and say “You know, I was wrong, I was really wrong”.  Somehow I don’t think that will happen.

However, aside from all the lost reimbursements, forwarded medication, confusion and swearing, we will again show the rest of the world that us retail pharmacists are the most stubborn, determined, hard working and just outright relentless healthcare professionals out there.  We are the glue that holds the industry together.  Its times like these that retail pharmacists and their staff show their true colors to all of their patients.

I can’t speak for all the retail folk out there, but I know there is a good majority that sat there after Jan 1st of 2006 and 2007, looked deep down into that tall glass of booze, and felt a sense of pride in their profession that wasn’t there before (or it might of just been gas, or psychosis setting in).

Taking the CARE out of WellCare

This is a directed bitch at WellCare. Yes, WellCare. I hope they read this, and I hope they give me an ‘offical reply’ to their stupid ass policies as you’ll see below. If you have a bitch about WellCare, then comment below. If I’m going to get a subpoena or court order to take this entry down (which I’m not, because its the truth), we mine as well go down swinging.
Its 5:30, right before closing. One of our terminal cancer patients (11159.2) came in with an Rx for some Duragesic Patches. He is out of oral meds, so doctor figured now would be a good time to put in him on the patch. He has WellCare. So we try to bill the Fentanyl Patches. Not covered. Hm, what about trade name? Nope. No fentanyl patches are covered. So we call the wonderful WellCare customer service number only to be told that there is NO provision for early, lost, or emergency override fills. We pleaded and told the douche that the patient has terminal cancer, and if there was any way to fill the Rx.
Short answer: No.
Long answer: No.
Who the fuck does NOT cover fentanyl patches? Its not like fucking that new quinine thats out. Fentanyl patches are used for one thing: Chronic or cancer pain. I bet they require a prior auth for all HIV medications too (because those arent important)! Anyway, back to the story:
They would fax to the doctors office a prior auth form which needed to be completed and sent back. This is on a Friday, at 5:30pm. Yeah, snowballs chance in hell of that being done. Even if he doctor did it that very moment it probably wouldn’t be processed until Monday.
Thats right, this terminal cancer, no pain medication, all because WellCare is ran by a bunch of fucking heartless idiots. The patient ended up shelling out a few hundred bucks for his patches so he wouldnt be hospitalized over the weekend.
I hope someone from WellCare reads this, and realizes how fucked up they are, what a shitty program they run, and how bad this makes them look. Figures they are processed by WHI AKA Wallgreens. “Pharmacy America Trusts” my ass. So to any of the big CEO’s or important people at WellCare: I, The Angry Pharmacist think you guys are fucking assholes and I hope someday when you get cancer from those $100 cigars and top shelf booze that YOU get to spend the weekend in pain because your insurance company dicked you over like you dicked over my patient.
Fuck Off and die.
The Angry Pharmacist

Medicare Part D – The Donut Hole, Your Doctor, and You

I’m not dead! I swear! I just have been busy with work and not drinking myself into a coma.
The Donut Hole.
Those three magic words that all Medicare Part D patients hope they never hear. The gap in coverage where you must pay out of your own pocket for your medications.
I hold Doctors partially to blame for the shit we have to go through when patients hit their donut hole. Before you give me hate-mail-o-rama, lets elaborate:
You have a patient who is on Medicare Part D. Suddenly, all of these new and spiffy trade-name medications are only $3.10! So what does the doctor do? He starts writing for that ARB when a generic ACE-I is okay. He starts writing for Lipitor when the patient has been on generic Zocor for months. He starts getting blowjobs and lapdances from the drug reps in return for prescribing Levaquin when generic Cipro would be okay. “Hell! Its only $3.10! Why not! The patient only pays $1 for generics, whats another $2.10 for a drug that works ‘better’!!!”.
In reality, the doctor is screwing over the patient, big time. In fact, he’s screwing over the patient more than anyone else could. You see, all of those big expensive trade name medications are going on a tab. A tab that pushes the patient further and further towards the donut hole. So their $2400 allotment of ‘coverage’ is now burnt up in 3 months because Mr “Its only $3.10” Doctor switched them all over to trade name medications. How many doctors realize this? About 10. How many doctors care? Zero.. “Its the pharmacists responsibility to take care of this, even though I’ll deny any generic request he submits!”
So who’s sitting there with their puds in their hands. Isnt the doctor, he gets his from the drug companies regardless. Its the patient and the pharmacist. The patient because he now has to pay out of pocket for $2,000 or so dollars until he hits “catastrophic coverage”; and the pharmacist because WE have to explain all of this shit to the patient and hear their whining.
Sure we can switch them all back to generics, but its a catch-22. If you switch them all to generics they’ll be in the donut hole longer (because their total cost of drugs per month decreased due to generic switch). If you keep on the expensive trade name medications, they’ll be out of the donut hole quicker, but will pay more per month. Wonderful isn’t it?
In the defense of doctors, they really have no clue how much stuff costs now days. If you’re a doctor, and reading this, the cost of the drug is directly proportional to how many annoying drug reps come and visit you. Why would a drug that cost pennies be pushed so hard by men in suits and women in short tops? Think about it.


Who here wants to drop Humana? Seriously. 2 friggin buck profit from each Rx. Where does Humana get off paying us this?
See, this is the inherit problem with the system(tm). Our best customers, the cash paying ones, have to subsidize the losses we take from taking retarded insurance plans like Humana. So who does this punish? Not Humana, they are reporting high profits this year (gee, wonder why). Not the patients, they pay their $3 copays while bitching the entire time. Its us and the private pay patients.
When are we going to put our foot down and say “I cant operate making $2/rx!” and stop taking Humana? Humana needs a good kick in the teeth to realize that if nobody takes their shitty plan, they are boned. Seriously. I hope Humana reps actually read this to realize that they are costing pharmacists their businesses. They need to get with the program. Their exec’s dont work for minimum wage, so neither should we.
Now I know you all may be saying “ho-hum, we’re used to it, same shit different day” but is it really? There are a bazillion Medicare part D plans out there, and the MediCare/MedicAid patients can change monthly! No excuse for them to switch to a similar plan that isn’t going to bend you over without lube! We aren’t dealing with the private insurance patients (obtained through their work) that are pretty much unchangeable. I realize that the non-Medicaid patients are pretty much screwed until November, well, cant win them all.
Send a comment if your pharmacy terminated their Humana contract. We’ve sent ours a bunch of times to their contract department, but so far no confirmation. Lets give Humana the bitch-slap they deserve for being the flithy whore of the Plan-D’s.