Can I please just keep this one good thing?
January 4, 2023 11:09 AM Subscribe
My work switched health insurance providers, and the new one I’m stuck with doesn’t contract with my beloved local independent pharmacy. Is there a way to fight this? Is it worth looking at other plans? Are there any upsides at all to being forced into CVS?
I have had the good fortune of being able to use independent neighborhood pharmacies for many years now, across multiple neighborhoods and insurance plans. I have always sworn I would never go back to a chain. Reasons I love my current pharmacy include:
-I have never had any difficulty getting my controlled substance scripts (Adderall) refilled.
-They will deliver everything to my house, including the adderall, and coordinate a time with me to ensure that I receive the drop-off. It’s the same driver every time, so he knows roughly what my schedule looks like.
-When I had a brief gap between insurance plans due to a payment snafu, the pharmacist let me pay a substantially lower than advertised out of pocket price for all my meds. When I asked why it was so much lower than what she had initially quoted me, she said “it’s my pharmacy and I make the rules.”
Today, that pharmacy called and informed me that my new insurance is tied to CVS. My nearest CVS is inconveniently located, consistently understaffed, and consistently described as a customer service nightmare by everyone who has to use it. I really don’t want to make this switch. I’ve never had to deal with insurance straight-up not covering a pharmacy anymore—meds and providers, yes, but not a pharmacy.
1) Is there any way to fight to get my current pharmacy covered? Probably not, right?
2) Before I had my current job, I had an ACA insurance plan that covered my pharmacy without issue, as well as all the doctors I see. It is more costly than my employer plan by a fair margin, but not so much so that it would totally wreck my budget. Would it be completely silly to go on the ACA for this? (My income is too high for any subsidy).
3) If I do suck it up and use CVS or some other thing that my insurance will allow, are there any tips to make the experience more bearable, particularly in regard to being able to consistently get my adderall on time? I see that I qualify for mail order through express scripts, but I’ve had occasional issues with package theft before and don’t want to risk dealing with stolen adderall.
Note; my doctors are all in a large local hospital network that accepts a wide range of insurances, I’m not worried that they’ll be covered no matter what I do. It’s only the pharmacy that’s a problem.
I am a healthcare worker myself and used to navigating insurance clusterfucks for other people but I have no clue what to do for myself, I hate this.
I have had the good fortune of being able to use independent neighborhood pharmacies for many years now, across multiple neighborhoods and insurance plans. I have always sworn I would never go back to a chain. Reasons I love my current pharmacy include:
-I have never had any difficulty getting my controlled substance scripts (Adderall) refilled.
-They will deliver everything to my house, including the adderall, and coordinate a time with me to ensure that I receive the drop-off. It’s the same driver every time, so he knows roughly what my schedule looks like.
-When I had a brief gap between insurance plans due to a payment snafu, the pharmacist let me pay a substantially lower than advertised out of pocket price for all my meds. When I asked why it was so much lower than what she had initially quoted me, she said “it’s my pharmacy and I make the rules.”
Today, that pharmacy called and informed me that my new insurance is tied to CVS. My nearest CVS is inconveniently located, consistently understaffed, and consistently described as a customer service nightmare by everyone who has to use it. I really don’t want to make this switch. I’ve never had to deal with insurance straight-up not covering a pharmacy anymore—meds and providers, yes, but not a pharmacy.
1) Is there any way to fight to get my current pharmacy covered? Probably not, right?
2) Before I had my current job, I had an ACA insurance plan that covered my pharmacy without issue, as well as all the doctors I see. It is more costly than my employer plan by a fair margin, but not so much so that it would totally wreck my budget. Would it be completely silly to go on the ACA for this? (My income is too high for any subsidy).
3) If I do suck it up and use CVS or some other thing that my insurance will allow, are there any tips to make the experience more bearable, particularly in regard to being able to consistently get my adderall on time? I see that I qualify for mail order through express scripts, but I’ve had occasional issues with package theft before and don’t want to risk dealing with stolen adderall.
Note; my doctors are all in a large local hospital network that accepts a wide range of insurances, I’m not worried that they’ll be covered no matter what I do. It’s only the pharmacy that’s a problem.
I am a healthcare worker myself and used to navigating insurance clusterfucks for other people but I have no clue what to do for myself, I hate this.
Best answer: A few thoughts:
-Ask your preferred pharmacy about non-insurance rates. Some drugs I take are ironically cheaper through certain uncovered pharmacies without my insurance.
-Ask your employer for the insurance provider's pharmacy service specialist. (Note: unless your employer is self insured, you won't disclose anything at all about your prescriptions to any of your HR.) Depending on the size of your employer, this may be a general help line or you may have an actual dedicated person with a name. Get connected with that group and ask for a special exemption just for you just for your one pharmacy. Worst they can say is no.
posted by phunniemee at 11:22 AM on January 4, 2023
-Ask your preferred pharmacy about non-insurance rates. Some drugs I take are ironically cheaper through certain uncovered pharmacies without my insurance.
-Ask your employer for the insurance provider's pharmacy service specialist. (Note: unless your employer is self insured, you won't disclose anything at all about your prescriptions to any of your HR.) Depending on the size of your employer, this may be a general help line or you may have an actual dedicated person with a name. Get connected with that group and ask for a special exemption just for you just for your one pharmacy. Worst they can say is no.
posted by phunniemee at 11:22 AM on January 4, 2023
We went through this (sorta) when our insurer switched us from Walgreens (close to our house, small, friendly staff, etc.) to CVS.
What I can say is that I discovered that a CVS *not* closest to our house is a lot more organized, better run, etc. than the closest one. And that the online Caremark prescription system actually works really well. I wonder if you'd be willing to have your meds delivered to you at work, and/or use a locked mailbox that'll fit the relatively smallish prescription package.
posted by BlahLaLa at 11:29 AM on January 4, 2023
What I can say is that I discovered that a CVS *not* closest to our house is a lot more organized, better run, etc. than the closest one. And that the online Caremark prescription system actually works really well. I wonder if you'd be willing to have your meds delivered to you at work, and/or use a locked mailbox that'll fit the relatively smallish prescription package.
posted by BlahLaLa at 11:29 AM on January 4, 2023
A minor upside to using a chain is that if you are traveling and forget your prescription, the chain can very easily verify the prescription and give you a few pills to tide you over until you get home (I’m sure they won’t do this for a controlled substance, and I don’t know how it would work with an expensive medication, but they’ve done that for me with my SSRI which is cheap and not scheduled).
Making it more bearable - mail order, especially if you can get a three month supply, is very convenient. Options to avoid package theft include ship somewhere else, like an office; see if you can pick it up at the post office/UPS store; get a smallish lock box that you can mount somewhere outside your home for the meds to be dropped into. I think my CVS also offers same day prescription deliveries during a 2hr window, though I’m not sure if they would do that for controlled substances.
posted by maleficent at 11:33 AM on January 4, 2023 [1 favorite]
Making it more bearable - mail order, especially if you can get a three month supply, is very convenient. Options to avoid package theft include ship somewhere else, like an office; see if you can pick it up at the post office/UPS store; get a smallish lock box that you can mount somewhere outside your home for the meds to be dropped into. I think my CVS also offers same day prescription deliveries during a 2hr window, though I’m not sure if they would do that for controlled substances.
posted by maleficent at 11:33 AM on January 4, 2023 [1 favorite]
When i had insurance with prescriptions through caremark/cvs, i had to pay a little more and couldn't get more than a 30 day supply through local pharmacies, but i could still use them. Does your new plan have out of network pricing for prescriptions?
worth making a couple of phone calls to find out.
posted by domino at 11:42 AM on January 4, 2023 [3 favorites]
worth making a couple of phone calls to find out.
posted by domino at 11:42 AM on January 4, 2023 [3 favorites]
Are there any upsides at all to being forced into CVS?
In my experience, no. CVS is almost universally bad.
The good news is that the above comments about still being able to fill prescriptions at a non-CVS pharmacy, but limited to 30 days, match my experience with insurance that switched over to Caremark-managed prescription benefits. CVS/Caremark really tries to strong-arm you into using their shit for maintenance prescriptions and I'm unsure how it's even legal and not restraint of trade, but several things turned out to be true for me:
1. Any short term prescriptions (like, say, a Z-pack for an infection) could still be filled (and in fact pretty much have to be filled) at any local pharmacy.
2. My doctor wrote prescriptions as 90 days (because I had asked when I tried mail order) but the non-CVS pharmacy had to fill them in 30 day increments. Your pharmacy may need to get on the phone with an actual person at the prescription benefit manager's office (which sounds like it's probably Caremark) but they should be able to figure out what to tell your doctor to make sure that your prescriptions get written in such a way that they can get paid for filling them.
3. The amount I paid out of pocket (deductible, co-pay) didn't seem to change appreciably.
If everything else fails, you can ask the pharmacist for the uninsured, out of pocket cost and look into things like GoodRx for other negotiated prices. If you do use GoodRx or something like it, you should comparison shop all the alternatives for every damn refill because the negotiated prices change frequently. The drawback to paying out of pocket is that the expenses won't count towards your deductible, but depending on your situation that may still end up being the best choice.
posted by fedward at 12:43 PM on January 4, 2023 [2 favorites]
In my experience, no. CVS is almost universally bad.
The good news is that the above comments about still being able to fill prescriptions at a non-CVS pharmacy, but limited to 30 days, match my experience with insurance that switched over to Caremark-managed prescription benefits. CVS/Caremark really tries to strong-arm you into using their shit for maintenance prescriptions and I'm unsure how it's even legal and not restraint of trade, but several things turned out to be true for me:
1. Any short term prescriptions (like, say, a Z-pack for an infection) could still be filled (and in fact pretty much have to be filled) at any local pharmacy.
2. My doctor wrote prescriptions as 90 days (because I had asked when I tried mail order) but the non-CVS pharmacy had to fill them in 30 day increments. Your pharmacy may need to get on the phone with an actual person at the prescription benefit manager's office (which sounds like it's probably Caremark) but they should be able to figure out what to tell your doctor to make sure that your prescriptions get written in such a way that they can get paid for filling them.
3. The amount I paid out of pocket (deductible, co-pay) didn't seem to change appreciably.
If everything else fails, you can ask the pharmacist for the uninsured, out of pocket cost and look into things like GoodRx for other negotiated prices. If you do use GoodRx or something like it, you should comparison shop all the alternatives for every damn refill because the negotiated prices change frequently. The drawback to paying out of pocket is that the expenses won't count towards your deductible, but depending on your situation that may still end up being the best choice.
posted by fedward at 12:43 PM on January 4, 2023 [2 favorites]
I don't think Adderall can be sent in the mail anyway, so you would be stuck going in for it unless they deliver. I know Target delivers but not sure about medication. Speaking of which, is there a Target near you? All of their pharmacies are CVS now.
mail order through express scripts
This is interesting because CVS and Express Scripts are competitors. I was forced to CVS like ten years ago and their mail order was handled by Caremark. Caremark messed up so much that I will do everything I can to avoid them now, including using my husband's health insurance instead of my employer's. I don't think you would be crazy to find an alternative plan, but please let your employer know what a bad deal this insurance is.
At one point I was on the phone with Caremark and asked why I have to go to CVS when the closest one to my address is 45 minutes away. They said I don't have to go there for everything, just the long term stuff. If you have other less important drugs (or have a few weeks stockpile of one of your other prescriptions), you might find mail order works for you if they will ship USPS and it fits in your mailbox. I can't have personal packages sent to my office, so that is not always a solution.
posted by soelo at 2:06 PM on January 4, 2023
mail order through express scripts
This is interesting because CVS and Express Scripts are competitors. I was forced to CVS like ten years ago and their mail order was handled by Caremark. Caremark messed up so much that I will do everything I can to avoid them now, including using my husband's health insurance instead of my employer's. I don't think you would be crazy to find an alternative plan, but please let your employer know what a bad deal this insurance is.
At one point I was on the phone with Caremark and asked why I have to go to CVS when the closest one to my address is 45 minutes away. They said I don't have to go there for everything, just the long term stuff. If you have other less important drugs (or have a few weeks stockpile of one of your other prescriptions), you might find mail order works for you if they will ship USPS and it fits in your mailbox. I can't have personal packages sent to my office, so that is not always a solution.
posted by soelo at 2:06 PM on January 4, 2023
Yes, we have CVS Caremark and we use a local pharmacy with no problem. This is what I have to do once a year, though:
At the beginning of coverage and again at the beginning of every year, my first prescription gets filled. Then the refill or second month, the pharmacy says they can't fill it because of CVS Caremark and I have to use their by-mail program. I call the number of the back of the card and tell them that I want to use my local pharmacy, and the customer service person says "oh yes, I can opt you in for that" and then they change my setting, and for the rest of the year I can fill my prescriptions.
As others have said, I can't get more than a month at a time from my local pharmacy. And every year I forget and get confused at the first refusal, call the number, and have to redo the opt in. It takes 5 minutes, though.
Good luck!
posted by gideonfrog at 5:06 PM on January 4, 2023 [1 favorite]
At the beginning of coverage and again at the beginning of every year, my first prescription gets filled. Then the refill or second month, the pharmacy says they can't fill it because of CVS Caremark and I have to use their by-mail program. I call the number of the back of the card and tell them that I want to use my local pharmacy, and the customer service person says "oh yes, I can opt you in for that" and then they change my setting, and for the rest of the year I can fill my prescriptions.
As others have said, I can't get more than a month at a time from my local pharmacy. And every year I forget and get confused at the first refusal, call the number, and have to redo the opt in. It takes 5 minutes, though.
Good luck!
posted by gideonfrog at 5:06 PM on January 4, 2023 [1 favorite]
My experience is much like gideonfrog's, though I don't have to renew the month-by-month thing every year. They bugged me about using CVS mail order for a year before I told them (via a phone call) that I get loyalty rewards at my local Fred Meyer pharmacy, and therefore save money on gas. Having to go to the store to get prescriptions every 30 days is no big deal; we're in there at least once a week. Somehow this shut them right up and they haven't bothered me since.
posted by lhauser at 6:10 PM on January 4, 2023
posted by lhauser at 6:10 PM on January 4, 2023
I seem to recall having had to have this stupid "opt-in" conversation with my insurance at least once.
posted by praemunire at 8:04 PM on January 4, 2023
posted by praemunire at 8:04 PM on January 4, 2023
Seconding Theiform. My (very expensive! allegedly good!) insurance covers medicine so poorly that I often don't even use it for my many, many meds. Instead I use GoodRX (ugh) or ask the pharmacist if they know any way to help, which they often do, though I'm not sure how that works since it seems to just be something they're doing on their computer. The point being that, depending on how many and how expensive your meds are, it might not be worth it to leave your pharmacy anyway.
I also especially don't recommend CVS-in-Target for important controlled substances you need at a certain time each month. My local one frequently fails to open at all for the day due to pharmacist availablility. Turns out huge corporations operating on lean scheduling aren't prepared for staffing issues during a pandemic, almost like they care more about their stock value than their actual business functions... but I digress. I guess it depends on the CVS, but I think you'd have much less trouble with the actual CVS stores.
posted by the liquid oxygen at 6:31 AM on January 6, 2023
I also especially don't recommend CVS-in-Target for important controlled substances you need at a certain time each month. My local one frequently fails to open at all for the day due to pharmacist availablility. Turns out huge corporations operating on lean scheduling aren't prepared for staffing issues during a pandemic, almost like they care more about their stock value than their actual business functions... but I digress. I guess it depends on the CVS, but I think you'd have much less trouble with the actual CVS stores.
posted by the liquid oxygen at 6:31 AM on January 6, 2023
I have this problem (and my employer chose a plan that I can no longer opt out like other answers described). My prescriptions are generic and inexpensive enough that I just kept going to the independent pharmacy. I still have the CVS coverage if that changes.
posted by sepviva at 5:25 AM on January 7, 2023
posted by sepviva at 5:25 AM on January 7, 2023
Response by poster: Good news-I called the pharmacy to check what the out of pocket costs would be for my prescriptions, and it turns out that everything is completely affordable.
I’ll also be calling my insurance to see if I can get an opt-out of the type gideonfrog describes, but for now I’m perfectly content to pay out of pocket to keep my sweet, perfectly timed home delivery.
Thanks all!
posted by ActionPopulated at 10:44 AM on January 9, 2023
I’ll also be calling my insurance to see if I can get an opt-out of the type gideonfrog describes, but for now I’m perfectly content to pay out of pocket to keep my sweet, perfectly timed home delivery.
Thanks all!
posted by ActionPopulated at 10:44 AM on January 9, 2023
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posted by Theiform at 11:22 AM on January 4, 2023 [5 favorites]