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Author Topic: UHC Specialty Pharmacy Class Action Suit Settlement  (Read 2839 times)

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Offline Piscean

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UHC Specialty Pharmacy Class Action Suit Settlement
« on: May 12, 2014, 08:49:57 PM »
It appears that a settlement has been reached in Doe v. United Healthcare. If approved by the court (final hearing July 14) class members will no longer be required to use OptumRx mail order for HIV meds. If this issue effects you, watch your mail for the settlement announcement. More info available at www.unitedhivsettlement.com

Offline Ann

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #1 on: May 13, 2014, 02:55:19 AM »
It appears that a settlement has been reached in Doe v. United Healthcare. If approved by the court (final hearing July 14) class members will no longer be required to use OptumRx mail order for HIV meds. If this issue effects you, watch your mail for the settlement announcement. More info available at www.unitedhivsettlement.com

Am I right in thinking that this settlement only affects those living in California?
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Offline Piscean

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #2 on: May 13, 2014, 08:36:09 AM »
Am I right in thinking that this settlement only affects those living in California?

I don't think so. The case was filed in Federal Court. IANAL, but I t is my understanding it applies in all states where UHC does business. I am not a California resident and I received the a notice advising that I am a member of the class.

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #3 on: May 13, 2014, 06:38:14 PM »
What was the suit about?
32 years hiv+ (oct. 2013) with a curtsy.

Offline leatherman

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #4 on: May 13, 2014, 07:15:45 PM »
What was the suit about?
if you were under any UHC plans and you had no other option than to receive your meds through the mail by a specialty pharmacy (chosen by UHC), you can now get meds at any in-network pharmacy. if you paid out more, because of having to use the mail-order pharmacy, you might be eligible for some sort of reimbursement

Quote
The “Program” referred to in the Notice is any program pursuant to which the only way for a person to obtain HIV/AIDS Specialty Medications on an in-network basis as part of their health care pharmacy benefit is to obtain HIV/AIDS Specialty Medications from a designated Specialty Pharmacy by mail. “HIV/AIDS Specialty Medications” means any medication prescribed by a physician that is subject to the Program and that Specialty Pharmacy identifies as a medication for the treatment of HIV/AIDS, Immune Deficiency, Growth Hormone Neutropenia, and Anemia, and any other category that may be agreed to by the Parties.

Under this settlement, members of the Class, as well as other persons with HIV/AIDS who are enrolled in or covered by health plans offered or administered by United or its Affiliates, will have the right to be exempted from the Program and will be able to obtain their HIV/AIDS Specialty Medications on an in-network basis at any in-network retail pharmacy they designate. Class Members will be able to exercise this exemption right or change their in-network retail pharmacy designation either by mail, facsimile, telephone or on-line. Class Members also will be able to request reimbursement of certain out-of-pocket costs they may have incurred as a result of the Program.
leatherman (aka mIkIE)


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Offline AusShep

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #5 on: May 13, 2014, 07:18:44 PM »
What was the suit about?

Being forced to use OptumRX speciality mail order pharmacy for HIV and other injectable meds instead of your local in network pharmacy.  I think the guy was from CA, claimed it violated CA privacy laws, interstate commerce, etc.  they settled instead of risking a more far reaching court result.

I actually liked OptumRx quite a bit, they made it easy to always fill early and build up a contingency supply.  Free overnight shipping, could use the copay cards, etc. 

I could care less if OptumRx or CVS make money on my Rx as long as my cost and availability are the same.  UHC likely saved money via lower costs with OptumRx which could keep insurance rates very slightly more under control, so it didn't bother me...



Offline Piscean

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #6 on: May 14, 2014, 09:40:10 PM »
I have had a mixed experience with OptumRx. I had a rough start, but their service has noticeably improved over the past few months. However, they still have issues applying my co-pay assistance properly which then messes up my FSA account.

Ultimately, I am in favor of this settlement. I believe consumers should have a choice when it comes to pharmacists and pharmacies. Until I was forced on to OptumRx I was using a Walgreen's HIV specialty pharmacy with a pharmacist certified in HIV meds. The pharmacy is in the same building as my physician which made for one stop shopping and easy to drop in for a quick consult if I had questions not answered by my doc. I valued that personal interaction as I consider my pharmacist a key member of my healthcare team. I never once was able to speak to an OptumRx pharmacist as the gate keeper customer service reps would never put my calls through.

I am also bothered by discriminatory policies of any kind. UHC created a second class of patient by requiring HIVers to get our meds from OptumRx. My diabetic coworker can get his meds from any in network pharmacy. My office mate is a cancer survivor taking daily, maintenance meds. She will be on meds for the rest of her life and has no problem getting meds from a an in network pharmacy. Why can't I receive the same service? 

It is not like we are being given carte blanche to get our meds wherever we want. We are still required to use an in network pharmacy so cost controls can still be enforced.

This settlement is a win for the consumer. It provides choice. Use OptumRx if it works for you or choose a local in network pharmacy if that is your preference.

Offline bocker3

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #7 on: May 14, 2014, 10:39:51 PM »
I believe consumers should have a choice when it comes to pharmacists and pharmacies.

You ALWAYS have a choice -- you can use any pharmacy you please.  You just have to pay more for it.

These sorts of "requirements" are things that help keep medical costs down - I have no major issue with forced to use a Specialty Pharmacy, if the entity shelling out tens of thousands of dollars for me requires it to save them money -- SO LONG, as said pharmacy is run efficiently and doesn't put patients at risk of running out of their meds.

Mike
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Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #8 on: May 15, 2014, 09:38:13 AM »
You ALWAYS have a choice -- you can use any pharmacy you please.  You just have to pay more for it.
My insurance company REQUIRES me to use ONLY Acreedo for my hiv meds. Should I choose to go out of network the ENTIRE burden of my med costs would be on me. $30,000.00+ per year. So, no Mike, you do not always have a choice unless you have the means.



Quote
These sorts of "requirements" are things that help keep medical costs down - I have no major issue with forced to use a Specialty Pharmacy, if the entity shelling out tens of thousands of dollars for me requires it to save them money -- SO LONG, as said pharmacy is run efficiently and doesn't put patients at risk of running out of their meds.

Mike
Acreedo has been a nightmare and has put me at risk, more than once. What are my options? Well, I'll tell you. None. (per Connecticut State Insurance Commissioner) So, yes, I have major issues with any insurance company giving me NO choice. The practice should be illegal. Glad you happen to be lucky enough to be satisfied with your insurance policy and specialty pharmacy but some of us are not and we are stuck.

32 years hiv+ (oct. 2013) with a curtsy.

Offline Piscean

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #9 on: May 15, 2014, 11:31:28 AM »
You ALWAYS have a choice -- you can use any pharmacy you please.  You just have to pay more for it.

These sorts of "requirements" are things that help keep medical costs down - I have no major issue with forced to use a Specialty Pharmacy, if the entity shelling out tens of thousands of dollars for me requires it to save them money -- SO LONG, as said pharmacy is run efficiently and doesn't put patients at risk of running out of their meds.

Mike

Sure, if could afford $30K per year out of pocket I would have all sorts of choices. But that is not reality. I would be less opposed to using OptumRx if they were easier to deal with and allowed me to access to an actual pharmacist.

I am fundamentally opposed to any rule or regulation that discriminates against people with HIV. This is a slippery slope that I feel we should all be vigilant about avoiding. I have no issue with other cost reducing procedures OptumRx and UHC have instituted such as "step therapy" and "pre-authorization" for certain meds. These policies apply to ALL plan participants and are not creating a second class for people with HIV.

As for cost savings, I am not convinced there are any. Based on my Explaination of Benefits, OptumRx charges more than the local pharmacy that I was using. Now there may be more going on behind the scenes with rebates to my employer or in the bookeeping between OptumRx and UHC, but all I see is that it costs more per refill. Did I mention that OptumRx is a wholly owned subsidiary of UHC? Somewhere (I cannot locate it now) an article was published covering this relationship and how this was not really about saving insurance plans money, but generating more profits for UHC. There was very little pass through of savings to the insurance plans. I will try to find the article and post a link.

Mitch, you have my sympathies. It sounds like Acreedo is far worse than OptumRx. Maybe this settlement will be a catalyst for future cases or force other companies to review their requirements to avoid potential litigation.

Offline AusShep

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #10 on: May 15, 2014, 12:40:43 PM »
If OptumRX is a subsidiary now, for bookkeeping it would make sense to keep more of the profit on the meds in OptumRx instead of UHC due to the profit limits on health plans where they have to give excessive profits back to the plan holders (this happened to me one year on UHC).  Did this happen when they switched from MedCo to OptumRx for all Rx billing, not just speciality, about a year ago?...

I doubt the pharmacy companies would be covered by that regulation.

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #11 on: May 15, 2014, 05:18:17 PM »
Thanks Piscean. Grinning and baring Acreedo.

The insurance companies have found a way around the NY law prohibiting them from forcing people to use specialty pharmacies just as they have in Connecticut although seemingly in different ways. I still don't understand how they get away with this sh*t.

 "However, independent pharmacists said pharmacy benefit managers, which manage prescription coverage for health plans, have found ways to get around the law, which called on brick-and-mortar pharmacies to meet certain terms and conditions to fill specialty medication prescriptions.

In addition to prices, those conditions might also include a 24-hour nurse hotline, a service not usually offered by a retail pharmacy."

http://www.buffalonews.com/20130602/state_urges_health_insurers_to_let_patients_buy_x2018_specialty_x2019_drugs_at_retail_pharmacies.html

AusShep- Yep, another maneuver to avoid returning money back to the policy holders if their profits go above the ACA threshold allowance if indeed they are owned by the insurance company. A serious loophole that would need plugging.
32 years hiv+ (oct. 2013) with a curtsy.

Offline bocker3

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #12 on: May 15, 2014, 06:05:16 PM »
First -- I know of your issues with Acreedo Mitch and this should NOT be allowed.  There should be a minimum standard of care and if a company can't meet that, then you should be able to go elsewhere.  I did not mean to imply anything different.  I've followed your travails with horror!

With that said -- if a pharmacy is giving proper service, then I think the entity paying has EVERY right to determine where you should buy.  of course the important thing here is that there MUST BE PROPER SERVICE.
As for the Explanation of Benefits -- what is CHARGED to an insurance company is almost never what that insurance company pays.  They negotiate rates.
Also -- unless they are requiring ONLY HIV meds to be gotten at this pharmacy, there is no discrimination -- I know that HIV is not the only condition required to use the Specialty Pharmacy under my Aetna plan.

Again -- if this means my premiums stay "low" (or rise less), I'm fine with this lack of choice.  I am only paying $60 for 3 months, so I haven't much financial skin in this.  They payer of the rest, however, is in for tens of thousands.  Oh -- and my company is self-insured, so Aetna isn't saving themselves money here, they are saving my company money.

finally -- my comment about choice is all about who pays.  If you want to pay, you go where you want.  If you want someone else to pay, you might be limited.  and, yes, I know that most can't afford to pay it all (I know I can't), yet the choice remains.

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
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Current Labs
May2013 691/31% <20

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #13 on: May 15, 2014, 07:03:17 PM »
First -- I know of your issues with Acreedo Mitch and this should NOT be allowed.  There should be a minimum standard of care and if a company can't meet that, then you should be able to go elsewhere.  I did not mean to imply anything different.  I've followed your travails with horror!

With that said -- if a pharmacy is giving proper service, then I think the entity paying has EVERY right to determine where you should buy.  of course the important thing here is that there MUST BE PROPER SERVICE.
As for the Explanation of Benefits -- what is CHARGED to an insurance company is almost never what that insurance company pays.  They negotiate rates.
Also -- unless they are requiring ONLY HIV meds to be gotten at this pharmacy, there is no discrimination -- I know that HIV is not the only condition required to use the Specialty Pharmacy under my Aetna plan.

Again -- if this means my premiums stay "low" (or rise less), I'm fine with this lack of choice.  I am only paying $60 for 3 months, so I haven't much financial skin in this.  They payer of the rest, however, is in for tens of thousands.  Oh -- and my company is self-insured, so Aetna isn't saving themselves money here, they are saving my company money.

finally -- my comment about choice is all about who pays.  If you want to pay, you go where you want.  If you want someone else to pay, you might be limited.  and, yes, I know that most can't afford to pay it all (I know I can't), yet the choice remains.

Mike

WOW! Speechless.
32 years hiv+ (oct. 2013) with a curtsy.

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #14 on: May 15, 2014, 07:20:33 PM »
i've been reading this thread, but don't really know what to add, or even how i feel about it.

i was only diagnosed a few 4 years ago. at the time worked for a very large well known airline. had uhc insurance, was required to use medco for my scripts, and they required me to use their specialty pharmacy. really that part of the experience was no problem. meds refilled every month on time, always by mail.

i held it together almost a year. then i had a storm of workplace/privacy/insurance issues that were mismanaged by all parties involved. me, company, and insurance. all that led to me leaving the job. and losing coverage. has left a bad taste in my mouth, but not really from UHCs specialty refill requirement.

mistakes were made.

« Last Edit: May 15, 2014, 07:45:40 PM by zach »
gonna go up to the mountain, for to find a little peace
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out across the hills, forevermore

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #15 on: May 15, 2014, 09:01:11 PM »
Ok, got my speech back as this topic and your views really push my buttons.
First -- I know of your issues with Acreedo Mitch and this should NOT be allowed.  There should be a minimum standard of care and if a company can't meet that, then you should be able to go elsewhere.  I did not mean to imply anything different.  I've followed your travails with horror!{/quote]
My travails are only mine but reflect the experience of so many others. Do you need a link? Should not be allowed? Ha! So what is your solution? You didn't mean to imply anything different? You clearly stated the same exact phrase as the woman from Acreedo when I complained of their lack of ability to fill my scripts without hassle and in a timely manner. "You have another choice". It pissed me off when she had the nerve to say it knowing that it would cost me $30,000+ and it pissed me off even more coming from another member of these forums.
Quote
With that said -- if a pharmacy is giving proper service, then I think the entity paying has EVERY right to determine where you should buy.  of course the important thing here is that there MUST BE PROPER SERVICE.
So you expect me to jump through even more hoops if the specialty pharmacy that the insurance company chooses isn't giving me "proper service"? I am simply too ill to fight for reasonable "service" month after month and yet you still believe "the entity" (ugh) has the right to put me through the wringer. You keep capitalizing things like "MUST BE PROPER SERVICE" but you never say what should be done if one doesn't get it. Easy to say. Not easy to fix with the rights you seem to allow corporations over patients rights. Jumping through hoops is detrimental to my health in itself. I don't need this stress of dealing with incompetence being forced on me. Nobody does that needs "specialty meds". (which NOW has come to  mean "expensive meds".
Quote
As for the Explanation of Benefits -- what is CHARGED to an insurance company is almost never what that insurance company pays.  They negotiate rates.
Also -- unless they are requiring ONLY HIV meds to be gotten at this pharmacy, there is no discrimination -- I know that HIV is not the only condition required to use the Specialty Pharmacy under my Aetna plan.

Again -- if this means my premiums stay "low" (or rise less), I'm fine with this lack of choice.  I am only paying $60 for 3 months, so I haven't much financial skin in this.  They payer of the rest, however, is in for tens of thousands.  Oh -- and my company is self-insured, so Aetna isn't saving themselves money here, they are saving my company money.
Once again, happy for you.

Quote
finally -- my comment about choice is all about who pays.  If you want to pay, you go where you want.  If you want someone else to pay, you might be limited.  and, yes, I know that most can't afford to pay it all (I know I can't), yet the choice remains.

Mike

What choice? Really. What choice?
Your own words admit that most cannot afford our meds but yet you STILL end your statement by saying we have a choice. I just do not see your logic unless you believe only those who can afford to spend their own money are those who have "a choice".

I seem to remember you saying you get your meds from CVS Specialty Pharmacy and that you have them delivered to your local CVS store. MANY OF US DO NOT HAVE THAT OPTION. There are some that have reasonable concerns about getting their meds stolen from their doorstep if they choose not to take the day off from work to sign for the package assuming it would even arrive when they said it would.

There are many issues you seem to turn a blind eye to but what others face on a regular basis.

"Saving costs" is not always smart and certainly is not compassionate when it comes to this topic.

Take a walk in my shoes and others in the same boat for a change. I want to hear solutions. You provided zip other than a concern to keep healthcare costs down at the expense of those who must fight in a stressful way to attain meds through this screwed up system and sacrifice our health in the process.



Well, I see I messed up the quotes. lol. Too tired to fix.  :P

ps- my apologies to the OP for the diversion.


« Last Edit: May 15, 2014, 09:06:54 PM by mitch777 »
32 years hiv+ (oct. 2013) with a curtsy.

Offline bocker3

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #16 on: May 15, 2014, 10:09:07 PM »
Mitch,

Look, I'm sorry that you can't read someone's opinion that is different from yours without personalizing it. 
Except for where I tried to point out that I felt for you and that what they were doing to you was unacceptable, I was never talking about you.  I was speaking in general.

So, I'm sorry that my position caused you such anger, but that is on you, not me.  We have different opinions about a lot of things - yet we also agree on a lot.  I don't get angry or personalize your views - well, except when you personalize them (I am allowed an opinion, even if I haven't a solution to a problem).  I read yours and, at times, I express my different opinion.  You've met, you know me -- I've met you and I know you.  I actually think your a great guy - the fact that we differ on some topics doesn't negate that in my eyes.  If it does for you, well, I'm sorry - I'd hate to lose a friend over an opinion difference, but I guess that's out of my hands.

Whatever you think -- I consider you a friend and would always be there if you needed it.

Hugs,
mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
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May2013 691/31% <20

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #17 on: May 15, 2014, 10:27:13 PM »
group hug guys, my read on this, it was nothing personal by bocker, but taken that way by mitch because he's ass deep in the shit right now, and has a short fuse for the topic matter. started with a misunderstanding, then a toe got stepped on.

i do get a kick out of bocker though, we have similar politics. sometimes i find myself nodding along in agreement to orielly. then i snap out of it. you hit less than bill. i try to be liberal, in spite of my conservative nature. always amused i find where my line is

i'm not involved in the class action, probably could be though. maybe i should look into it. what do i get? gift fruit basket maybe?

the lawyers are going to get rich here. anyone else might get two dollars and twenty-seven cents
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline Jeff G

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #18 on: May 15, 2014, 10:32:37 PM »
Did you just call Bocker Bill O'Reilly ... say it isn't so !

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #19 on: May 15, 2014, 10:39:13 PM »
only a little... i have the same sort of reaction to both, hiding my agreement, slowly reaching for the remote before anyone notices i agree with orielly sometimes
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline Jeff G

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #20 on: May 15, 2014, 10:52:37 PM »
only a little... i have the same sort of reaction to both, hiding my agreement, slowly reaching for the remote before anyone notices i agree with orielly sometimes

I would rather deal with the stigma of aids than the stigma of being a Bill Oreilly admirer LOL .    :)

Offline bocker3

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #21 on: May 16, 2014, 07:47:01 AM »
For the record, Zach -- Other than when he appears on the Today show, I have never, ever watch Bill O'Reilly....  I swear on all my grandkids! 
Fox News is as much a waste of time as MSNBC, IMO.

M
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline Jeff G

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #22 on: May 16, 2014, 08:04:33 AM »
For the record, Zach -- Other than when he appears on the Today show, I have never, ever watch Bill O'Reilly....  I swear on all my grandkids! 
Fox News is as much a waste of time as MSNBC, IMO.

M

Don't you be talkin bout my Rachel Maddow .

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #23 on: May 16, 2014, 08:39:46 AM »
i want one picture, of cooper and madow with pink nerf bats, beating the hell out of oreilly wearing a diaper... in a room full of bubbles
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #24 on: May 16, 2014, 02:04:40 PM »
Mitch,

Look, I'm sorry that you can't read someone's opinion that is different from yours without personalizing it. 
Except for where I tried to point out that I felt for you and that what they were doing to you was unacceptable, I was never talking about you.  I was speaking in general.

So, I'm sorry that my position caused you such anger, but that is on you, not me.  We have different opinions about a lot of things - yet we also agree on a lot.  I don't get angry or personalize your views - well, except when you personalize them (I am allowed an opinion, even if I haven't a solution to a problem).  I read yours and, at times, I express my different opinion.  You've met, you know me -- I've met you and I know you.  I actually think your a great guy - the fact that we differ on some topics doesn't negate that in my eyes.  If it does for you, well, I'm sorry - I'd hate to lose a friend over an opinion difference, but I guess that's out of my hands.

Whatever you think -- I consider you a friend and would always be there if you needed it.

Hugs,
mike

Mike,

Please tell me a solution to my dilemma. I've asked several times with no answer. It seems you hold onto the opinion that if one is stuck with an awful specialty pharmacy one must put up with the negligence and hassle or, as in my case, fork out tens of thousands of dollars until bankruptcy at which point Medicaid would be my only option.

I'm sorry if you thought I was getting too personal. I probably went a bit too far but when someone states an opinion that tells others, me included, that the choice is between substandard care or going broke I get pissed.

I respect your right to have whatever opinion you wish but it doesn't mean I must respect that opinion.

Zack was right. I have a short fuse on this subject and it keeps getting shorter when someone voices an opinion that seems to lack much empathy. Starting with an empathetic statement does not negate what follows.

Once again, I am thrilled for you and everyone else that are satisfied with their specialty pharmacy. Many others are not, including myself.

Here is a woman's blog site that shows others fabulous experiences with Acreedo. Read the comments.

 http://mixedupmommy.com/2013/11/12/how-is-accredo-pharmacy-getting-away-with-this/

My solution is for the insurance companies to allow people to use a pharmacy of their own choice to prevent the harmful effects of companies like Acreedo. Yes, even if it costs a bit more in insurance premiums which I think would be minimal if any at all.

Your solution? I really haven't heard anything other than you think these companies should be held to a higher standard. Well me too! Your solution on meds being delivered that bake in a mailbox, get stolen, or keep someone home from work to sign for the package? I haven't heard you even address this issue.

I'm just trying to have a dialog about the problems that exist now as the system allows. Not until these issues are addressed will I believe the so called savings are worth it. Forced pharmacy choice should have at the very least been forbidden until these kinks were all worked out. In the mean time peoples health are at risk.

Mark









32 years hiv+ (oct. 2013) with a curtsy.

Offline bocker3

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #25 on: May 16, 2014, 05:05:34 PM »
Mitch,

First -- I didn't state that if one is stuck with an awful specialty pharmacy once must put up with the negligence and hassle or pay tens of thousands of dollars.  I was pretty explicit that if a pharmacy is not providing proper service, they should not be the only option.  Actually, they should be shut down, IMO.
The solution to your problem -- I wish I had one to give you.  Other than your insurance company stepping in or a regulatory agency stepping in and forcing a change, I don't have the answer.

However, I also don't think that the answer for bad service at some pharmacies is to throw out totally an insurance company's ability to rein in costs by negotiating rates (and volumes) with some pharmacies.  People bitch that Bush pushed through Medicare D without allowing negotiation of rates -- this is the same thing.  The main difference is that the individual insurance companies don't have the same volume as the Feds do with Medicare.

There should be someone, somewhere who can step in when a company has a track-record like Acreedo seems to have.  Ideally, at the federal level, but at least at a state level (frankly, the insurance company should be the first line of defense, but that is wishful thinking).

As you know -- I think the true answer to this and most other frustration in our health care delivery system is to go to a single-payer system.  That probably isn't going to happen in our lifetimes, however.

So -- I do have empathy for you -- and I tried to convey that.  However, I also don't think that we get to solutions by using extreme examples (Acreedo) to create general approaches (controlling drug costs).  We must address the extreme, but that is not where you build the general.  IMO.

One last point -- for clarity -- when I said the OP had choices -- it was because he was crying discrimination, he wasn't complaining about derelict service.  I would have never said that in your case -- a pharmacy that can't provide a minimum standard of service should not even be allowed to operate, let alone be anyone's only option for insured service.

Hope that helps clarify -- not expecting you to agree, but I hope it clarifies.

Hugs,
Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #26 on: May 17, 2014, 01:48:29 PM »
Mitch,

First -- I didn't state that if one is stuck with an awful specialty pharmacy once must put up with the negligence and hassle or pay tens of thousands of dollars.  I was pretty explicit that if a pharmacy is not providing proper service, they should not be the only option.  Actually, they should be shut down, IMO.
The solution to your problem -- I wish I had one to give you.  Other than your insurance company stepping in or a regulatory agency stepping in and forcing a change, I don't have the answer.

However, I also don't think that the answer for bad service at some pharmacies is to throw out totally an insurance company's ability to rein in costs by negotiating rates (and volumes) with some pharmacies.  People bitch that Bush pushed through Medicare D without allowing negotiation of rates -- this is the same thing.  The main difference is that the individual insurance companies don't have the same volume as the Feds do with Medicare.

Well, you seem to be saying two completely different things in these two paragraphs. Which one is it? Do Acreedo customers get shoved under the bus or not? You express empathy and then go on to say so sad too bad, it's better to cut costs. Yes, I think the government should be able to negotiate rates but it could be done without pharmacy choice restriction but that's a whole other topic.

Quote
 

There should be someone, somewhere who can step in when a company has a track-record like Acreedo seems to have.  Ideally, at the federal level, but at least at a state level (frankly, the insurance company should be the first line of defense, but that is wishful thinking).
I agree but how much would that add to the costs? UNTIL such a system is in place I believe insurance companies should not be allowed to be doing what they are doing. People are getting hurt NOW. I for one would not sacrifice the quality of care of some to save a few bucks on premiums for everyone.

Quote
As you know -- I think the true answer to this and most other frustration in our health care delivery system is to go to a single-payer system.
There is something we do agree on.

Quote
So -- I do have empathy for you -- and I tried to convey that.  However, I also don't think that we get to solutions by using extreme examples (Acreedo) to create general approaches (controlling drug costs).  We must address the extreme, but that is not where you build the general.  IMO.
Again, so sad too bad. If the extreme examples are not addressed then people are tossed under the bus. Why not address this issue and others such as delivery and privacy issues before allowing insurance companies to dictate our place of med purchases? That is why I think it should not be legal, at least at this point. Why defend the practice in the mean time? Again, people are getting hurt now.

Quote
One last point -- for clarity -- when I said the OP had choices -- it was because he was crying discrimination, he wasn't complaining about derelict service.  I would have never said that in your case -- a pharmacy that can't provide a minimum standard of service should not even be allowed to operate, let alone be anyone's only option for insured service.


Hope that helps clarify -- not expecting you to agree, but I hope it clarifies.

Hugs,
Mike
Thanks for the clarity. I agree with much of what you have said but if you still believe that forced med buying is the best approach prior to resolving these inherent problems I respectfully and vehemently disagree. The status quo is putting lives at risk.

hugs,
Mark
32 years hiv+ (oct. 2013) with a curtsy.

Offline bocker3

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #27 on: May 17, 2014, 05:07:24 PM »
Well, you seem to be saying two completely different things in these two paragraphs. Which one is it? Do Acreedo customers get shoved under the bus or not? You express empathy and then go on to say so sad too bad, it's better to cut costs. Yes, I think the government should be able to negotiate rates but it could be done without pharmacy choice restriction but that's a whole other topic.

there is a "Not" missing in my post -- as in, the answer is NOT.....  sorry for the confusion.

I will not be going tit-for-tat with you.  We disagree here and I have tried to be agreeable in my posts - you, not so much.  In fact your latest post and your PM are bordering on pissing me off, as you aren't just making points, you are painting me in a light that I don't think is fair and are putting words in my mouth. 

Quite frankly, your emotional rants in this thread help buttress my earlier point -- using emotions and extreme examples is no way to set policy.

Hugs,
Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #28 on: May 17, 2014, 05:21:25 PM »
 :'( i hate it when daddies fight
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mitch777

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #29 on: May 17, 2014, 05:46:17 PM »
:'( i hate it when daddies fight

Sorry to bring tears to your eyes. It sometimes happens that daddies can't seem to communicate well with one another. Things will get better. I promise.  :-*
32 years hiv+ (oct. 2013) with a curtsy.

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #30 on: May 17, 2014, 11:53:52 PM »
 ;) just tryin to lighten the mood
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline buginme2

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #31 on: May 18, 2014, 02:27:19 AM »
Speak of the devil.  I received a letter in the mail today from my insurance company stating if I switched to their specialty pharmacy they would send me $100. 

I threw it away.

You have a choice? That's absurd. 

That's probably the most absurd thing I've read on here in a very long time.  There are a lot of people with HIV that have unstable or shaky housing issues.  An insurer forcing them into a mail order pharmacy might be good business but it's horrible healthcare.  There probably a thousand other examples as to why it's not only bad healthcare but immoral as well.

But they could always just pay out of pocket. Right? 

Online zach

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #32 on: May 18, 2014, 07:17:15 AM »
bug, valid point on the unstable housing of many. during the time i used uhc, medco, then specialty... first it was mailed USPS from medco, and that was almost immediately an issue (that i didn't raise with them, i had a small stockpile) but when i was transferred to the specialty pharmacy meds were shipped fedex, very well packaged and always on time. i even had the delivery driver dropping the package through the antique mail slot on the backdoor and he never had a problem with that.

i had stable housing at the time. "choice" never really entered the equation in my situation... truly, the specialty pharm was the solution, and in the time i've been in care, was the easiest experience i've had getting meds

medco shipped a 90 supply, but would not accept atripla copay assistance card. the specialty pharm only shipped 30 days but did accept the card. they also had a very smooth automated system that auto called me (an issue if the patient doesn't have a cell phone i guess) few days later meds arrived, always a few days before last bottle ran out

(my weed guy delivers to my door too, bless him)
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline Jeff G

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #33 on: May 18, 2014, 10:02:38 AM »
I was forced to get me diabetes testing supplies from a mail order company and I have come to have major issues with it .

They are very aggressive and will hound me to reorder even when I made it clear that I do not need to place an order ... the calls come sometimes 3 or 4 times a day .

They have called me 4 times this month even after I got my 3 month supply of testing supplies to inform me that I qualify for a free penis pump and a back brace . I informed them each and every time that I do not suffer form erectile dysfunction and do not need the product .

Last week the same person called to make the same offer and I told her no again and not to call me ever again about the matter . It wasn't a half hour later the same person called back to tell me I should let them ship me a penis pump and back brace because medicare and medicaid was not going to pay for them next year and that I really needed to place the order . She told me they are FREE so she didn't see why I had a issue with it . I asked her how in the fuck is something free if medicare and medicaid is paying for it but she didn't miss a beat and pointed out that although I didn't need the product now I might need it later . I got another call yesterday with the same offer . I have a drawer stuffed full of supplies that I never ordered from this company that are being billed to medicare and medicaid . I have reported them but I wont hols my breath waiting for things to change .

These mail order company's are making huge profits and abusing the system and patients who are forced into using them and I cant see why anyone could think that its good healthcare . It also stifles competition in the market place and is simple bad for business other than the ones we are forced into using . These company's are not trying to contain healthcare cost, they are directly part of the problem of why its so expensive and non responsive to the people they serve .

     

Offline a2z

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #34 on: August 04, 2014, 04:42:52 AM »
if you were under any UHC plans and you had no other option than to receive your meds through the mail by a specialty pharmacy (chosen by UHC), you can now get meds at any in-network pharmacy. if you paid out more, because of having to use the mail-order pharmacy, you might be eligible for some sort of reimbursement

Just as an update, our company just got UHC and I have been forced into the mail order pharmacy (OptumRX) for my meds.  Though I got to admit, UPS and getting to see my doctor were much bigger problems than Optum in getting my first shipment.
Dates are blood draw dates:
9/4/14: CD4 948, 37.9%, VL 150
5/23/14: CD4 895 --.-% VL UD - Truvada/Isentress
09/21/09: CD4 898 27.0% VL 120 - back on track, same meds.High level enzymes, but less so
06/15/09: CD4 478 21.8% VL 1150 - high liver enzymes... looks like I may not be resistant
05/22/09: Fixed insurance, resumed medicine
04/17/09: Ran out of medicine, could not resolve insurance problems
04/01/09: CD4 773 28% VL 120 - high liver enzymes
12/01/08: CD4 514 23% VL 630
10/17/08 started Reyataz, Norvir and Truvada. -- possibly minor neuropathy, but otherwise okay.
9/10/08: CD4 345 17%, VL > 78K
8/18/08: CD4 312 18%, VL > 60K (considering meds)
12/19/07: CD4 550 28% VL > 100K (no meds yet)
Diagnosed 10/23/07

Offline skyeblue

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #35 on: August 05, 2014, 12:26:28 PM »
I to have been forced into the mail order world (CVS Caremark) AKA Hell. I have been trying for 6 weeks to get my Atripla with no luck. My cost for a 3 month supply is $1491.17 and the Ryan White program has sent them 2 checks which CVS says they have never seen either of. I ran out of meds but luckily my Dr had some and gave me a 2 week supply. I am down to 5 days again and still can't get my prescription filled. I do not understand how we can be forced to use the mail order program.

Also, the first check was sent in on 7/2 and my script was filled on 7/16 and then reversed. I do not understand how that happened if they never received a check.
I am beginning to think they just do not want to fill my script because of the cost.

I am to the point of not knowing what to do. I feel like a junkie trying to get a fix. This has consumed my life.

Offline skyeblue

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #36 on: August 05, 2014, 01:11:32 PM »
Since my last post I found a Copay assist card for my Atripla that covered my whole copay. I should have my meds tomorrow.
So my advice is to do a web search for assistance programs to help with cost.

Offline a2z

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Re: UHC Specialty Pharmacy Class Action Suit Settlement
« Reply #37 on: August 24, 2014, 06:05:19 PM »
A follow-up.  I seem to be eligible, for whatever reason, to be able to fill my meds 22 days after I order the previous prescription.  This is nice, as right now my supply of Tivicay is only about 17-18 days ahead, and I'd like to extend that to 33 to deal with whatever situation may come up.

skyeblue - I also found copay cards in July, and a way of managing Optum that I like.  Since I'm only forced into the mail order pharmacy for my HIV drugs, and they each have copay cards, I don't have to deal with the financial stuff of Optum.  But I do have to call in and order each time, which is a pain. 

Still dealing with them on another matter, on which they are a giant pain in the butt, but at least the most important two drugs, I'm getting in a timely manner and with only minor grief (prior authorization for the Truvada.)
Dates are blood draw dates:
9/4/14: CD4 948, 37.9%, VL 150
5/23/14: CD4 895 --.-% VL UD - Truvada/Isentress
09/21/09: CD4 898 27.0% VL 120 - back on track, same meds.High level enzymes, but less so
06/15/09: CD4 478 21.8% VL 1150 - high liver enzymes... looks like I may not be resistant
05/22/09: Fixed insurance, resumed medicine
04/17/09: Ran out of medicine, could not resolve insurance problems
04/01/09: CD4 773 28% VL 120 - high liver enzymes
12/01/08: CD4 514 23% VL 630
10/17/08 started Reyataz, Norvir and Truvada. -- possibly minor neuropathy, but otherwise okay.
9/10/08: CD4 345 17%, VL > 78K
8/18/08: CD4 312 18%, VL > 60K (considering meds)
12/19/07: CD4 550 28% VL > 100K (no meds yet)
Diagnosed 10/23/07

 


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