December 19, 2012
Specialty Pharmacies Unscripted
by Larry Kramer
The founder of ACT UP fights back after being told he couldn't use his pharmacy of choice.
On November 19, I received a curt letter from Empire BlueCross BlueShield, which has insured me since I worked as a trainee at Columbia Pictures in 1958 or so.
“Our records show that you are getting the medicines(s) listed below from a retail pharmacy. It is important to note that beginning 01/01/2013, your medicine must be filled through our specialty pharmacy, CuraScript … If you stay with your retail pharmacy, the medicine won't be covered.”
Enclosed was a list of most of my anti-HIV and hepatitis B drugs that I am taking. It is a complicated list. Over the years, I’ve had a lot of complicated illnesses. My pharmacist at Bigelow knows me and my list and my doctors well. I rushed over to show the letter to Bruce, who shook his head sadly. “It’s happening all over the place.” Bigelow is the oldest apothecary in America. I asked him, “But why are you being punished, instead of the greedy drug companies? Why am I being punished?” OK, we’ve been here before.
The fun starts when I finally get someone from CuraScript on the phone. I could not believe what she was telling me. In essence she was saying, “You people are abusing the privilege of being insured by us, stocking up on your drugs, whether you need them or not.” “How do you know that?” “Our research has showed us that.”
I asked, “Who exactly do you mean by ‘you people’?” By then she must have sensed this wasn’t going to be an easy one, and said, I guess sensibly, that unless I had some other way to pay for them “you might as well give me your info now so you don’t miss your next doses.”
Then began a quite ridiculous series of easily 40 phone calls, all recorded, all to just let Laurence Kramer or someone who can speak for him know that his paperwork is in the process of being completed. “There is absolutely nothing you have to do to respond to this call.” My nurse practitioner told me she’d phoned in all my “specialty” prescriptions along with the day for their delivery to match the end of the current supplies.
I got a call from a service representative to set up a delivery date. “Now, could you tell me how many pills you have left?” she asked. “You want me to count them all right now? Empty six bottles of pills?” “You have six full bottles of pills?” she said, as if she caught me out in her raptor vice. “But you should know by the last time your insurance paid for it.” This was a new one on her. There was a long silence while she tried to figure out how to handle this one. “You people,” I heard once again.
We settled on December 24 for delivery of “five prescriptions.” I know that more were phoned in, but she mangled the pronunciation of all of them so badly that I decided to see what I was sent. I did inquire if Dr. Fung’s request of not using a generic for Prograf [a drug used to lower the risk of organ rejection] had been honored and she said she had no idea.
So this is what I have to deal with for the rest of my life? I can’t bear thinking of all the trained Bigelow pharmacists being replaced by these brain-dead service representatives all over America.
Taking care of all my sick brothers and sisters, my people indeed.
I had been invited to a party given by [the former head of Empire] Mike Stocker. I wasn’t going to go. I just got out of really grueling surgery a few days ago. Mike Stocker and I have known each other since the early days of HIV when he ran Empire. I was the activist who gained entrance into his office and yelled at him nonstop about what they weren’t doing for us. He told me to sit down. We both learned a lot from each other and have become good friends.
I asked him if he knew that his company, that had once been so grand, was now so hateful. Is this what he wanted to be remembered for? He introduced me to Mark Wagar, Empire’s current president, retiring at the end of the year. They were not unfamiliar with what I was complaining about. CuraScript has not been without personnel problems.
I tried to shame each of them. “But is this what you want the company you ran for so many years to be remembered for? Screwing the pharmacists. Screwing the patients. Punishing us. Bigelow has provided me my meds for over 50 years.”
Why doesn’t anyone fight back? Why do I have to get my meds mail order from people who don’t understand the meds they’re talking about? Also, isn’t there a civil rights violation going on here?
On the way out Mike asked me, “Is what you are asking for no more CuraScript?” I said, “I want Bigelow back.” Leaving, I realized that the passion and fire were still in me. After the operation last week, I doubted I had any left. Spencer Cox’s death didn’t help.
I think all of us who want to choose and use our own dispensers should be free to choose them. You people, indeed.
Search: Larry Kramer, Empire BlueCross BlueShield, CuraScript, Bigelow
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comments 1 - 15 (of 50 total) next
Johndoe, , 2014-04-03 17:07:08
I work for one of these mail order sp pharmacies. If you tell them that you live in an area that you do not trust to leave the package out front and you cannot stay home to wait for it and you are afraid if someone opens it that it will be a violation of your HIPAA rights they will grant a long term override to a local pharmacy of your choosing. You have to request the long term override on the basis of privacy concerns from a supervisor or lead. Hope this helps.
Kerri, NY, 2013-05-21 14:10:25
Is there any action going on in NY to stop Empire BCBS from forcing us to use Curascript? Class action lawsuit? Petition? We need to do something!
Alison, Swansea, 2013-05-16 14:42:09
Legal action didn't work. Anthem cancelled contract w/Curascript for everything. Telling patients they can choose between CVS CareMart or Coram. 2 options, effect is the same for specialty drug patients. I choose to use Walgreen's. I can't.
Arthur, New York, 2013-02-17 16:43:45
At the end of this article about CA trying (and has succeeded) not to be forced to use Curascript - it says that a law was passed in NY saying Curascript cannot be mandatory but a choice. I see no info about this anywhere. Does anyone else who is using Empire BCBS know of a law that was passed?
www.thebody.com And the article is called Stop Anthem Blue Cross From Compromising Care of HIV-Positive Clients
Eric, , 2013-02-05 14:46:58
I see I am not the only one having problems with United Health Care and their OptumRx. Incompetent company that usually has various "processing" errors and never has my two prescriptions in sync and it always seems one is expired and I have 11 refills on the other even though my doctor showed me he faxed them together and identical refills. There needs to be a lawsuit against United Health Care/OptumRx. How does one get that started?
Julie, Bronx, NY, 2013-01-17 09:14:54
There is an attorney from NY listed on a class action in CA for this same issue. Maybe some of us can contact her to do a class action in NY.
WHATLEY KALLAS, LLC
Edith M. Kallas To Apply Pro Hac Vice
2 380 Madison Avenue, 23rd Floor New York, NY 10017
Jeffery Parks, Benbrook, TX, 2013-01-15 16:44:49
I think we need to get the ACLU to file suit to stop this type of action in its tracks before it starts incorporating more of us. Many of us have specifically picked our Pharmacist team and as such, are an integral part of our healthcare team. They not only check drug interactions, but know us and check for oontraindicatios against conditions we have such as kidney failure bcuz they get to know us personally. It's MY CHOICE to pick my own healthcare team....including Pharmacy & Pharmacist(s).
Luis R, New York, 2013-01-10 16:44:24
I work in the pharmacy industry and have seen many of my clients face the same dilema. The worse part is we have no control over what these big companies want to dictate. I find it shameful and disgraceful aside from diserving the real need of clients. We ought to do some advocacy to fight the demons of big insurance carriers before they end up restricting all aspects of health care.
MASTER MAT, BOSTON MA USA, 2013-01-10 14:35:24
HMO BLUE, IS NOE MAKING ME USE EXPRESS SCRIPTS, THEY TOLD ME IT WOULD TAKE A FEW WEEKS, MONTHS LATER, THEY R STILL HAVING PROBLEMS. ALSO SOMEONE THERE TRIED T0 USE MY SOVERGEIN BANK CARD TO BOOK A ROOM IN A RESORT IN THAT AREA. 11 OTHER SOVERGEIN BANK CUSTOMERS, HAD THE SAME PROBLEM. ITS AN ONGOING NIGHTMARE...
Julie Pena, Bronx, NY, 2013-01-08 09:27:27
I've been dealing with this issue since last year when i was forced to use the mail order. I had to educate them to enroll in ADAP so that my copayment can be covered. They didn't even know what ADAP was. I don't like dealing with them (OptumRx), I rather have a face to face contact with my local pharmacist instead of dealing with someone over the phone in KS who doesn't even know anything about me. I'm so ready to do a CD to protect my right to chose!
Peteskier, Deltona FL, 2013-01-08 09:06:28
This discrimination needs to be stopped. Cigna now requires me to fill with their Home Delivery Pharmacy and they will not bill ADAP so I pay 140 myself. When I call to order my one perscription I am transferred to 3 different people and they are rude and warn me that if the perscription gets lost in the mail I will have to pay the full amount of 5375.40 for it. Everytime I call in to refill I get so depressed because I feel discriminated against and there is nothing I can do about it.
Todd, , 2013-01-05 12:32:20
Activists need to find Congressional allies to DEMAND that ExpressScripts (Medco has now been purchased by them), Curascript, and all of the others at least be compelled to coordinate payment benefits with ADAPs, Medicaid and other third payers.
Todd, , 2013-01-05 12:29:50
I work with a State ADAP which pays co-pays for insured members. These mega-mail order pharmacies are refusing to work with State ADAPs and Preexisting Condition Insurance Plans to allow them to pay these co-pays at the point of sale. This means our clients have to arrange to have a check cut to pay for the medications in advance. Not only is it unnecessary bureaucracy, but it is horrible for compliance, and if not stopped, it's going to overwhelm our ADAP's ability to coordinate this payment.
Bennett Goldworth, Ft Lauderdale, 2013-01-04 05:52:42
I recently got diagnosed with HIV. If dealing with this disease wasn't difficult enough, to have my insurance carrier to which I pay many thousands of dollars a year for many many years is now able to dictate to me to rely on a mail order pharmacy and limiting that order to a 30 day supply is unacceptable. As a result, I order every 21 days so I can build the reserve so the irony here is they don't fix the problem they want to and no one wins here. I would love to join Larry Kramer in his fight
Steve NYC, New York, 2013-01-04 01:00:51
comments 1 - 15 (of 50 total) next
This BCBS policy effectively disqualifies them from covering anything coordinated Medicare part D filled meds. Nor will BCBS coordinate with ADAP. This is outright discrimination. A class action law suite needs to be brought and petitions to the state commissioner of insurance. But good luck with that as BCBS has bought off that agency.
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