The segregation of HIV meds and patients at CVS/Caremark

[Phil]

I am enrolled in the Blue Cross Blue Shield medical insurance for federal employees. Recently, CVS/Caremark (Caremark) won the contract to provide prescription medicine services, beginning Jan. 1, 2012, replacing the contract with Medco. I received some HIV meds in the mail yesterday (February 28, 2012), and there was no paperwork regarding the refill of my meds. I called and over the course of 90 minutes spoke with 1) a gentleman at the Specialty Pharmacy, 2) a lady at the Mail Order Pharmacy, and 3) a gentleman in the Executive Department. (I won't divulge the names in this posting to protect the employees.)

Caremark had the contract a few years ago, before the recently expired contract with Medco, and there have been some changes. The employees I spoke with told me the following:

* HIV drugs (and some others) have been classified by Caremark as a Specialty drug, requiring specialty handling.

* The Specialty Pharmacy is completely separate from the regular mail order pharmacy. They do not share records, systems, or any other information other than the name. The regular mail order pharmacy cannot see any refill information (and vice versa), so no-one can recognize any potential side effects, possibly missed by my doctor, that could result in a mixing of new HIV and/or other drugs.

* I cannot order specialty medicines via the internet as I can with regular meds, reportedly part of the special handling to protect my health records. As a result, I have no written record of when I ordered my meds or the scheduled refill date.

* In addition, there is much to the specialty meds "that I would not understand", with ordering, storage, delivery, etc., which is another reason why the meds cannot not be refilled from a website. How does the storage and shipment of my Selzentry differ from that of my blood pressure medication? In addition, when Caremark (and Medco) had their previous contract, they managed to get all my meds to me (well, mostly), all from the same department, even though some of my meds at the time were refrigerated.

* I can order my HIV refills by waiting from someone from Caremark to call me so that someone can check up on me to ask whether I have had any adverse reactions or whether my prescriptions have changed. I countered that this was no-one's business but mine and my doctor's. I was told I could refuse to discuss my health situation, but I'm not entirely sure they're allowed to ask me these questions unless I specifically request the assistance of one of their pharmacists. I was told that this was part of the special handling, a service provided by my personal representative. I suspect that my personal representative has at least hundreds of clients, if not more.

* I can call and order my meds myself, but I'd need to calculate the time from the filling of my prescription to 75% of the 90 days of the prescription, or about 68 days. All three Caremark employees gave me this line like it was from a script. It was also suggested to me that I could ask my personal representative at Caremark to send me a written record of my meds and the refill dates. I appreciate the offer, but I can track my med dates myself (and I do, but I'm sure there are plenty of clients who do not). More importantly, I don't want to leave this up to my personal representative (see potential client load, above).

* The number of employees with access to my medical records in the Specialty Pharmacy is much smaller than the number of employees with access to the records in the regular mail order pharmacy. Why the discrepancy? For that matter, why does anyone needed access to my meds records unless, again, I specifically ask for a consultation with a pharmacist?

* All 3 employees I spoke with were amazed to learn that the refill date was not printed on the label of my meds. I was even asked, "Are you sure?  Are you looking at the bottle now?"

* I think that my biggest complaint is that my usual drugs that I could skip occasionally, e.g. high blood pressure (ironic, no?), etc., can be ordered from a website that tracks my orders electronically and gives me a written record. My HIV drugs, which I need to live and cannot miss, rely either upon a personal representative (see potential client load, above), or I must assume responsibility for ordering my meds. Again, that is not a problem, but there is still no written record of when I placed my order. Humans can act with the very best of intentions, and I'm sure the employees at Caremark are very conscientious and recognize the heavy responsibilities given them. However, humans make mistakes, and I am more comfortable with computerized records I can see and retrieve.

Complaints can be lodged at the BCBS customer service number, 800-848-9766. Ask to speak to a supervisor, tell them it is for personal reasons, and get his/her name immediately. The moment you use the words "mail order pharmacy", you will be immediately cut off  with the excuse "this line does not handle mail order complaints, only issues with doctors", followed by an immediate transfer to the mail order department. They in turn will attempt to transfer you to the Specialty Pharmacy.

Because BCBS makes it difficult to file a complaint, I asked the gentleman in the Executive Department for the telephone number of the Caremark office that handles the federal contract. After some clarification that I can in fact be given this information, I was promised a return phone call in 24-72 hours. To be fair, it has only been 29 hours; however, I would think that this information would be almost immediately available to someone in the Executive Department, especially someone handling complaints about the performance of the federal contract.

Interestingly enough, I was indirectly contacted today by an employee of Caremark (through the email of someone he used to date).  He claims that all my points are either incorrect or the fault of BCBS. Meanwhile, I have posted this information on two different sites for HIV+ social clubs in the Washington, DC metro area, and have been besieged with responses from those encountering problems with the Specialty Pharmacy.
 

[idee]

I used to go through problems with the employees staring at me when I picked up my meds at CVS so I switched to Walgreens. The service is much better and they know me by sight now and start looking up my and my hubby's meds as soon as we walk in.

[emeraldize]

"I am enrolled in the Blue Cross Blue Shield medical insurance for federal employees."  Have you raised the issue with an HR representative at your place of work?

[Phil]

No, but thanks, that's a good idea. I've been playing phone tag with someone at Caremark, and will call BCBS today.

[Rhaegar]

I'm surprised you can't reorder your HIV meds online.  My insurance company also utilizes CVS/Caremark for prescriptions.  I can log into my account online and electronically refill all of my HIV medications.  Maybe it's the level of service contracted with BCBS?

My biggest problem with CVS/Caremark is that they absolutely suck at actually getting me my meds when they say they will.  Every 3 months is a insane game of phone tag that usually ends up in me raising my voice at them.  Stop calling me to say they're being sent out, just send them.

[denb45]

I hate BCBS, they really SUCK as an Ins. company, and I want my Medicare part D back, but that ship has already sailed, I'll NEVER see my part d medicare again 

[bocker3]

I think it is more about BCBS and/or your employer.  I have Aetna and last year, Rx coverage switched to Caremark.  I am much happier with them.  I can refill and pick up my 90 day " mail order" scripts from my local CVS.  This makes it much easier for me.  I do not have to use the Specialty Pharmacy for my drugs, Atripla, Reyataz and Norvir.  So it is not CVS/Caremark that is segregating you, as they aren't doing that to me.

Mike

[klipsch]

My niece is a Pharm D for CVS on the fast track to a DM position at their headquarters. I'm gonna ask her what she knows about this policy debacle. This might be a stupid question...but what's the reason for mail ordering HIV meds, instead of just picking them up at the pharmacy? Is it due to the lack of ADAP coverage in some states? I'm on Medicare myself, and just popped out the other side of the doughnut hole this week.

[Buckmark]

Phil,

I'm late to the party here, but as Mike said, I think this has more to do with your insurer or employer, than with CVS / Caremark.  My employer just switched to CVS this year, and my HIV meds are not on any specialty list.  I can order them online and have them delivered via mail order, or I can call them in to my local CVS pharmacy and pick them up there. 

Regards,

Henry