My health insurance provider, Blue Cross Blue Shield of Massachusetts, currently uses Express Scripts as its mail-order pharmacy. They’re switching to CVS Caremark as of January 1, 2023, which as you’ll see from below is probably a good thing. However, if your insurance company is still using Express Scripts, then I to encourage you to think long and hard before using them for anything, at least not without going into it knowing that you’ll have to be extremely vigilant to ensure that they don’t screw up and screw you. Read on to see what I mean.
I logged into Express Scripts recently and noted the following:
- They showed me a long-term medication prescription for my daughter and told me I could save money by ordering the prescription through them rather than getting it from CVS.
- They showed me a prescription for a one-month supply (one-ounce tube) of a skin cream that I had recently filled at CVS with a $30 copayment and told me that if I ordered a three-month supply from them it would only cost $60 instead of $90.
- They showed me a prescription for my adult daughter who is still on my insurance and told me it would be cheaper to refill it through them, a clear HIPAA violation because there is no way they should be showing me information about my adult children’s prescriptions.
I dealt with the last of these by filing a privacy violation complaint with Blue Cross (they advertise a phone number on their web site for precisely this purpose). I’m waiting a month to hear back from them about the status of my complaint before following up, though honestly, I suppose it’s mostly moot since like I said as of January 1 Blue Cross won’t be using Express Scripts anymore. 🤷
Let’s talk about what happened with the other two…
They billed Blue Cross for my daughter’s medication, then decided that they needed more information from her prescribing doctor before they could fill it. They (supposedly) reached out to the doctor asking for more information (she has no record of having received such an inquiry), sent us a vague email about how they were waiting for information from the doctor, and then… did nothing for six days. They didn’t tell us specifically what they needed so we could follow up directly with the doctor. They didn’t try to reach out to the doctor again. They didn’t notify us that they hadn’t heard back from the doctor. They just did nothing. By this point my daughter was nearly out of medication, so I went to the CVS where we had previously filled the prescription to get it filled there instead. They said they couldn’t fill it unless we paid out-of-pocket because since the insurance company had already paid Express Scripts for a three-month supply they wouldn’t approve another fill for three months. I ended up paying for a week’s worth out-of-pocket so my daughter wouldn’t run out of medicine while we were straightening this out, and then reaching out to the doctor directly and asking her to resolve it, which she was able to do quickly once she was aware that there was something that needed to be resolved.
Regarding my skin cream prescription, they sent me… a one-ounce tube, i.e., exactly the same amount of medication that CVS sold me for half the copayment that Express Scripts charged. Yes, that’s right, Express Scripts charged me twice as much for the same amount of medication and claimed that it would last three times as long. I sent them a loud complaint through their web site and told them they needed to either give me back $30 or send me two more tubes. We’ll see what happens.
I’ve heard plenty of similar stories from other people. It seems pretty clear that the only time Express Scripts is worth using is you have a long-term medication that is significantly less expensive from Express Scripts and you are able to get the prescription over to them far enough in advance that you have plenty of time to resolve issues when they screw it up. Even then you shouldn’t use them unless you’re prepared to stay on top of things and make sure they process your prescriptions promptly and don’t overcharge you.
For a lot of plans, Express Scripts isn’t just the mail order pharmacy. They’re the pharmacy benefits administrator, meaning they handle all the prescription claims including for physical pharmacies. So you can’t really choose not to do business with them.
In my case, they stole $20 from my credit card which they had on file for a mandatory mail order medication. It happened around when I mail ordered some free covid tests from their website. But I don’t know if that’s what triggered the fraudulent charge, since FIVE different phone agents could not tell me what the charge was supposedly for. After more than an hour on the phone, I reached a supervisor who still couldn’t figure it out, but just gave me the money back to be done with it.
I complained to my employer’s benefits department about how awful Express Scripts is. I’m not sure the complaint reached the right person, but they’re dropping Express Scripts anyway, so I guess that’s all I could ask for.