Suggestions/Experiences Medco vs. CVS Caremark!

[TLD412]

So I have my appointment to discuss treatment options next Tuesday and I have been trying to get everything in line for my medication attainment. Side note, I'm really hoping to get a one a day regimen but of course that will be up to the doctor.

My question in regards to this is which provider have any of you had better experience with? I have the option to use either because I have coverage through both of them. I am thankful to have this coverage but me being indecisive makes it more difficult to choose lol. I'm weighing this and that and it's about to make my head explode.

Here's some plan information, the best I've researched through my online accounts with each company. Medco: The drugs I'm interested in are covered. It states that I will have a flat rate of $125 for either the retail location for 30 days or the 90 day supply through mail order. I did the cost estimator or what not and it did not have any side notes like pre auth or anything like that. It said this drug is covered and of course coverage can change. It says flat "Yes, this drug is covered" then has this message when clicked on: "This medication is covered.Please note that the coverage terms of this prescription benefit are subject to change."

As for CVS Caremark when I did the medication cost estimation it had a cheaper retail amount but the same amount for mail order. Retail was $80 vs $125 mail order. However it never directly says this drug is covered like it did on the medco/express scripts site. So I'm wondering if that would have to be mail order. Of course with them there is the option to have sent to local pharmacy. But would it be considered speciality since is not on my actual coverage list?

The drugs I were interested in were one-day regimens Atripla and Stribild. Thats what I was pricing in case that would help further.

Also I found it odd that when i checked the total cost for each company they differed so completely. On the Medco site it sd they cost total $100,000+ don't recall the exact #'s but my plan covered basically 100% of it and cvs cost was just the company cost annually which did not total more than $2000/year.

Anyways anybody who can offer me any insight or advice on this I'd greatly appreciate it!!! I know I may be counting my chickens before they hatch with the medications on looking for without actually talking to my doc but I'm wanting to have a plan and everything in line once he decides which meds I will be using!

Thanks.

[intaglio]

Medco is now ExpressScripts, at least in my neighborhood,

If you go with Medco/ExpressScripts, they will not accept the pharmacy company's copay assistance programs through their mail-order service. (stupid, stupid, stupid IMHO) If the prescription program mandates you use the mail-order pharmacy, you would have to file your copay reimbursement with each pharmaceutical company individually. You would then have to 'float' your copay until reimbursed.

For the combo I take, Prezista, Norvir and Epzicom, ExpressScripts does not mandate, they only encourage me to use the mail-order pharmacy. Getting my drugs filled locally allows me to use the copay programs at the time of purchase. This saves me having to 'float' about $250/mo. The drawback is that I can only get one month of each at a time.

YMMV.

[zach]

i dont have time to write much. i know this will be the unpopular view. i used medco/xpress script while i was on atripla. the specialty mail order they used worked well for me. they would only do 30 days at a time. medco itself did not, but the specialty pharm accepted the atripla copay assistance card last i knew. my out of pocket was zero, i think two months i paid $75. i know there are many complaints about moving to a mail order based model. thats a valid political argument, and i do think we should have the choice. but fact is, this is the direction they are moving us. and i have seen it work

i never had an issue with med refills. currently, under a more traditional system, i have steady issues.

today in fact, which is why i have to go. four days of meds left, call in system (automated only, medco specialty at least had an opt out of the auto system and a human option) says i have no refills left (seriously?! i'm on this crap for life) only way to speak to a human is to drive down there. resolve the issue. and drive back probably next week once my dozen meds are refilled. twice the gas and miles. could have been resolved by phone. this never happened with medco. my fault though for taking it for granted. thinking i'd be slick and wait until the night before, call in my refills, and be able to conveniently pick them up on dr visit. on a friday. lesson learned.

but medco is the bad guy right now i guess

[TLD412]

Intaglio thanks for response, lol yes it is express scripts here as well. Thanks for the info! I did read here that you have to do a reimbursement form if you use the mail order pharmacy. Honestly I see the benefit to both lol. Mail order and retail location pick up. Mail order I could have a longer supply and would be less worried about running out. I live in a smaller area and don't believe my primary pharmacy would have the meds on hand but would rather have to get them shipped in! So when I would go to refill a thirty day supply that would concern me lol! How long would it take them to get the hiv meds! Walgreens is the chain, if curious.

Zach I don't think your point of view is that frowned upon lol. It seems like a lot of people prefer the mail order system. As far as I can understand I am approved to do either the retail option or mail order. Of course my first course will probably be retail but I will most likely do mail order. I like with retail I can use copay assistance right then but I don't like the limited supply.  Living in the south during the summer also concerns me if I have to evacuate for a hurricane I wanna have enough supply to last me!!! When you say more traditional what do you mean? Are you still with medco?

But that is crazy, lol. Yes this is a lifetime deal common sense says unlimited refills. Come on get your sh*t together. Hopefully it works out for you today. But I hear you. We live and we learn!!!! That's all we can do.

[BT65]

I believe it would depend on your state and the individual insurances.

I am on a Medicare Part D plan and I currently pick up my prescriptions locally at a CVS, which is about 2 minutes from my apartment.  I've used this CVS for the past, about 15 years, so that is why I continue with them; I know the pharmacists and we have an okay relationship.

However, I have heard many, many complaints about CVS and their lack of customer service etiquette.  If I did not already have a relationship with the pharmacists, I would probably use another pharmacy.

I know this is probably not much help for you, but if you have specific questions, you may want to contact the pharmacies directly to get answers to your questions.

[mitch777]

I have been forced to use Acreedo which is a specialty drug division of Express Scripts since last November and have had to struggle for hours on the phone with them 6 of the past 8 months. This week once again was promised shipped dates twice and still no meds. AVOID them like the plague!

[ARMANDO]

I've been using CVS SPECIALTY PHARMACY,THEY ACCEPT THE ASSISTANCE CARDS for all my meds AND they do supply you a 90 day supply,so my bid is for CVS CAREMARK.

[bocker3]

I have had good experience with Caremark - not perfect, but no worse than I've had with retail pharmacies.

[intaglio]

Mail order I could have a longer supply and would be less worried about running out.

The last I spoke with a ExpressScripts rep, I was told that, if I used their mail-order pharmacy, I would still only receive my meds in 30-day increments. This was due to the expense of the meds. So, for me there was no benefit to using mail-order, only drawbacks.

I live in a smaller area and don't believe my primary pharmacy would have the meds on hand but would rather have to get them shipped in! So when I would go to refill a thirty day supply that would concern me lol! How long would it take them to get the hiv meds! Walgreens is the chain, if curious.

I use Walgreens locally, also. They requested I give them three-five days notice when it's time for refills. If I request a refill Mon-Wed, they can have them ready for pickup by Friday. If I refill on Thurs-Sat, they won't have the refills ready until Monday or Tuesday.

I use an app on my phone to scan the barcode on the bottles to notify them I need refills. As a matter of organization I routinely request refills on the 14th of the month for a pickup date the Friday that follows. This gives them enough time to order the meds.

The biggest challenge has been using the copay programs. Walgreens' prescription system has no easy way for the pharmacy tech to apply the copay. The tech must be familiar with the issuing company's program and how to apply it through Walgreens' system.

Plus, their pharmacy tech has informed me multiple times they could not apply the copay, for it to go through when they tried again while I was standing there. Being familiar with the vagaries of computerized systems, I understand why this issue occurs.

If you go the Walgreens route, sign up for their balance rewards program. They award generous points for prescriptions. You can then use the points to discount your other purchases made separately.

[TLD412]

Thanks for all the replies guys!

I really appreciate yall's advice!

You have no idea, again thank you lol!
Anyways I had my treatment appointment today and I ended up using my medco insurance through Walgreens.

My total copay was $125.00 but I ended up paying $0.00 for my HIV meds. I used the Gilead copay assist card. Intaglio that's funny you say that because the 1st time the lady ran it she said that the medicine selected was only covered for females not males. I was like I didn't see that stipulation anywhere. I ended up calling the hotline for the card and the rep found that amusing she said they must have done something wrong. Sure enough another lady ran it and it went through knocking copay to $0.00.

I also see where they say to refill 5 days prior, so I will be on top of that. I'm just glad to have medicine finally!!!!! 

[intaglio]

I'm just glad to have medicine finally!!!!! 

Congratulations. I hope you easily develop a routine and integrate your HIV prevention maintenance into your life. Having the meds on hand goes far in being able to do this. 

I used the Gilead copay assist card.

You should have or will receive documentation outlining how long this assistance is in effect. Make a note of it for future reference. You'll need to re-up your enrollment after you receive your final prescription under your current eligibility. You won't be given any notice -and Walgreens will not know your eligibility has ended until they try running the copay through and it is declined.