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F***ing idiots at insurance companies.
  #1  
Old 04-25-2012, 03:47 AM
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Shalom Shalom is offline
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Default F***ing idiots at insurance companies.

OK, I'm gonna name names here.

I just got a fax at work from an HMO for Medicaid patients that the majority of the patients in my store are covered by, detailing the changes to the prescription drug formulary that were published today.

They go into effect in three days. That's right, published April 24, 2012, effective April 27, 2012. Three fing days to give doctors a chance to evaluate them, determine which of their patients need to have their therapy changed because they won't be able to afford to pay out of pocket for these drugs, and try to arrange for exceptions if in their professional opinion the therapy they're already on has been optimized and they don't want them changing. This despite their own literature stating that they will give 60 days notice of such changes.

Not only this, but their own damned website only has the last formulary from October 2011 on it. The new one isn't available for download anywhere that I can see; if you didn't get the fax, you're screwed.

But that's just the usual idiocy. That's not what I'm pissed off about. (Well, not so much.)

No, what's got me steamed is that one of the changes is that Albenza and two other anthelmintics have been removed from the formulary. The only anthelmintic remaining on the formulary is mebendazole.

Which was discontinued last September and is no longer available in the United States from any manufacturer!

Bad enough that the freaking doctors haven't got the message yet and still insist on prescribing this shit that we haven't been able to get in months and likely won't any time soon, but this totally unavailable medication is the only one that these imbeciles at Fidelis will pay for.

It makes you wonder sometimes. It really does.

  #2  
Old 04-26-2012, 09:18 AM
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How does that saying go, 'do not attribute to malice what can be explained by incompetence'?

Sounds like they are making incompetence look very good by comparison.

  #3  
Old 04-26-2012, 11:14 AM
Zaiida Zaiida is offline
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*Facepalm* That's....that's all kinds of stuufed up special with hells bells on. My sympathies.

  #4  
Old 04-26-2012, 08:58 PM
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Wow that's all sorts of fucked up. I feel for everyone involved with this mess, believe me. And these people are the ones that hold people's healthcare in their hands? Scary, scary.

  #5  
Old 04-27-2012, 01:03 AM
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Wow, that's some industrial strength fail right there. You have my sympathies.

  #6  
Old 04-27-2012, 01:29 AM
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There's a simple solution to this problem.

Tell every patient who complaints to file a complaint with the Insurance Board.

That'll fix 'em.
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  #7  
Old 04-27-2012, 05:11 PM
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So here's an update on the situation.

Today, April 27, the revised formulary is finally published on the website, the very day it goes into effect. The letter likewise shows up. I notice that the language promising the 60-day notice period for formulary changes is mysteriously missing. I wish to G_d I'd saved a screenshot of that. It's 1984 all over again: "but we've always been at war with Eastasia! You must be misrembering, Citizen." You shouldn't be allowed to edit history in real life. G_d damn it.

(And it really is in effect: we're getting rejects on stuff that's been covered since forever.)

As far as the Mebendazole thing: Hanlon's Razor states, "Never attribute to malice what can be adequately explained by stupidity." However, in this case, I really do sense malice. How so? Well, I called a СѴЅ nearby and asked whether they had mebendazole in stock. Of course they did; he seemed surprised that I would even doubt whether they have such a common item.

Now who administers the pharmacy benefit for Fidelis? СѴЅ/Сагемагк, of course.

They can't restrict you from going to any pharmacy you want; Aide of Right tried that when they bought PCS and there was a huge backlash. So what did they do? They must have bought up the entire last production, squirreled it away in their warehouse, and cornered the market, so anyone with a prescription for mebendazole has to go to them for it.

(How do I know they did this? I was there when they did it the first time. Remember when the old generic albuterol inhalers were pulled off the market because they had R12 as the propellant? СѴЅ bought up the entire last production run from Apothecon, cornered the market, and then had us take them out of the boxes and dispense them in 60-dram vials. What was the point of wasting money like that, I hear someone ask? Because the box bore a notice that the product was immanently being discontinued, and they didn't want their customers to know. Then of course Сагемагк wouldn't pay for brand name Proventil/Ventolin/Proair HFA, which were the only ones still in production with R134a ("HFA") propellant; no, they only paid for the generic albuterol, which was only available . . . guess where.)

They did the same thing when Apotex brought out the generic Plavix and was forced to pull it shortly thereafter. It's nothing but a backhanded way of ensuring a captive customer base. Illegal? Probably not. Unethical, or just sharp business practise? I think I'll abstain on that one.

Naturally, when СѴЅ bought Сагемагк, they swore on a stack of dictionaries that they would keep the PBM and the pharmacy separate, and deal with СѴЅ stores just like any others.

  #8  
Old 05-03-2012, 02:53 PM
suburbandecay suburbandecay is offline
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Quote:
Quoth Shalom View Post
S I wish to G_d I'd saved a screenshot of that.
I just wanted to point out that if this letter was on a publicly available website, it might still exist in the google cache or at archive.org.

  #9  
Old 05-08-2012, 01:52 PM
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Quote:
Quoth suburbandecay View Post
it might still exist in the google cache.

HA !!!
Good catch, SD!

Am I hallucinating, or does this document not say,
Quote:
Quoth lying_bastards_at-Fidelis
"We will notify you of the change at least 60 days before the date that the change becomes effective"?
And does this document not say,
Quote:
Quoth LBaF
Generally, if you are taking a drug on our 2012 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2012 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost‐sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.

If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of 1/1/2012.
No, I'm not hallucinating. These documents actually do say that.

And do they not also say,
Quote:
Quoth LBaF
if [...] the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary
? Yes, by golly, they do say that. So what about mebendazole??? Been off the market since last October, but it's still the preferred drug on the formulary (because they've got all of it)?

Bastards.

  #10  
Old 05-10-2012, 10:04 PM
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I hope you've saved these in something else; and ...somehow get them to the State authorities? Can that help?
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