Hey, folks. Welcome to 2020, and all the insights that come with being in the rear view mirror. As the sun sets on 2019, I’m looking back at things I have learned, and realizations that are taking me full speed into a year with an extra day under its hood.
Last year, I learned how broken the idea of a pharmacy benefit management company has become in the United States. I had my go-around with Express Scripts, in which my glucometer sensors arrived several days late, and it was as if I were pulling teeth to get an urgent fill at my local pharmacy so I could keep an eye on my blood sugar.
I never did replace the electric bicycle that broke in December 2018, but that’s okay. I spent more time on the manual transmission bike, and also started going to the gym. The exercise proved beneficial, even though my commute ability decreased by a range of a few miles. Going to the gym net me a few hundred dollars from my employer through their fitness benefit program, and for half the year, I felt inspired enough to complete the goals. This year, I’ll punch higher.
I relearned that there are terrible folks when it comes to hosting, in the form of paying the folk at Bigfoot Servers for a second year of service, and having them close shop in December. May they date a horny cactus for the rest of their lives. I’m over on Namecheap now; I’d post an affiliate link, but their new affiliate program is a bit of a headache to sign up for.
I finally replaced my ebook reader with a used early generation Barnes & Noble Nook Glowlight. If I could reclaim the internal storage space to have more storage for my books, I’d be happier. Been reading a bunch of fan fiction in my evenings after work, and maybe I’ll actually get around to reading some stuff from my public library again. Repositories of free science fiction epubs are always welcome, by the by.
I got my blog to announce its presence via ActivityPub, thanks to a couple of WordPress plugins, making me readable and followable via Mastodon and similar suites as I post (Hi, @firstname.lastname@example.org!), and can still tweet my new posts.
Speaking of tweeting, it seems my post on my ordeal with Express Scripts was definitely my most read and circulated post of 2019, and drew a lot of traction via Twitter, Facebook, and even was shared via LinkedIn. I’m flattered, amused, and slightly spooked at the same time.
But, enough of this for now; I must actually go eat to fix a number that I wouldn’t have been able to see without my replacement glucose sensor. Thanks again to my local FredMeyer Pharmacy for throwing hammers to help. 💙
A thought. I gently label it “The American Pharmaceuticals Industry needs a full re-flow. Bake off the bad solder joints, get some fresh stuff in place, and remember the people.” and float on.
Prior to this week, I was relatively tolerant of the idea of a mail order pharmacy, having been forced by Express Scripts to switch, find my way to Walgreens, or only get 30 day supplies of my medicine. This also came with colorful documentation to be like Kyle, who gets all of his prescriptions mailed to his doorstep, doesn’t have to spend time going to the pharmacy, etc.
A preface: I do not hate Walgreens in the context of this discussion. Walgreens, however, isn’t located in a good location with regard to transit in this story. Two buses on different roads run through and turn to head the same direction that I need to go. To get to a stop that allows you to catch either bus without having to find out which bus is coming next (requires: smartphone or a paper copy of both schedules), one must walk a little over a quarter mile to the combined stop. FredMeyer is equidistant with regard to stop access, but has the advantage of not requiring an additional step to get to a grocery store while out grabbing pills. Albertson’s, with their Sav-On Pharmacy, wins for distance with a six hundred foot walk to a combined bus stop — the same one I’d get to on foot if I went to Walgreens, incidentally.
My prior insurance carrier, Providence, allowed me to have 90 day fills at ANY local pharmacy, which I grew quickly fond of after coming off the state’s Medicaid programme — only having to go every 90 days to a pharmacy of my choosing, getting all my scrips synchronized so I don’t have to go frequently and remember to pick up pills, and the like? Who wouldn’t like that kind of convenience, seriously?
Express Scripts would only give me that level of access if I went to Walgreens.
When you think about that, for people who don’t or can’t drive, you bet they’re going to want to line up their travel to be as direct as they can. If I’m going to have to spend a bunch of time waiting on buses, or having to take a Lyft or a taxi, you bet I’d rather have also picked up my groceries while being out to pick up my pills and shots, so I can just go home when I’m done. If I’m wanting that, I’m sure I’m not alone on it.
So, for the current carrier, to continue getting my quarterly supply of pills, injectables, and nasal sprays, I complied by migrating most of my medicines over. My insulin and my GLP-1 agonist were two of the last three to be migrated, and those were done slowly, one at a time to make sure that things weren’t going to go pear shaped at a bad time. I had extra weeks of each medicine at the time of migration, and wasn’t immediately compelled into this. Everything arrived timely, even though my only incentive was to get medicine in bulk then.
Things were fine, and I was back to a point of spending less personal time going to the pharmacy. I then got my fCGM. Express Scripts was very particular about how I got this filled: I could only pick up ONE sensor at a time, every two weeks.
This irks me for a number of reasons:
I’m not even allowed a one month supply of sensors. That is, two sensors at a time.
Sensors are attached to the skin with glue. If something pulls it off, I can’t replace it until either the manufacturer sends me a new sensor, or insurance approves an emergency pharmacy refill. Both tasks can take days.
I’m not even afforded the courtesy of a backup to remove some of the urgency in case of a sensor removal event.
I now have to visit a pharmacy every two weeks, because heck my personal time, it ain’t worth jack to them.
I tolerate this up until Thanksgiving, though — I got that prescription filled a couple days early, because it’s a holiday weekend, and it’s a good thing that I did. I had my first unplanned sensor pull the Saturday after Thanksgiving, with nearly a week left on it. I was able to clean and sanitize the site, and apply a new sensor that I would normally not have had on hand if my local pharmacy hadn’t been awesome and filled ahead of the weekend.
It was at that point that this incident, combined with reading the next year pamphlet for my prescription benefits and seeing the clause about being required to move maintenance prescriptions to mail order or Walgreens, or be denied fills after two courtesy local fills that I decided I’d bite and start the migration after my next local fill to get that process out of the way. It would get me sensors to have on hand, and I could deal with the manufacturer sending me a new sensor kit in the interim is where my thought process took it.
Now, I’m sort of laughing at myself after all this, but it’s not for the reasons some of you might think.
Hello again, I’m Xial (pronounced ‘Zeal’, rhymes with ‘eel’). By day, I’m a non-emergency medical transport dispatcher. I help people get to their doctor’s appointments, pharmacies, and the like as part of their health plan benefits on a same day urgency basis. Something that my personal health insurance doesn’t offer, but theirs does.
One of my personal gripes at work had been with folks needing to go to the pharmacy so frequently. I am guilty of grumbling about folks that should be using their mail order pharmacy benefit, because the very line of work I do makes me aware of the cost of transportation.
This week’s events, rather tellingly, changes my tune from “use your mail order benefit” to “Please ask your local pharmacist to synchronize your prescription refills, so you don’t have to go four times a week.“
It changes because I’ve learned how horribly inefficient mail order pharmacies can be when they screw up for the populace, and so many people are afraid to give them access to an opportunity to screw them up. I hadn’t encountered the screw-up, and the ineptitude of Express Scripts when handling these problems, so I was very much a blind eye for the darker side of mail order.
People are justifiably afraid of what can happen when mail ordered medicines don’t arrive on time, or arrive in unusable conditions. We’re in the colder part of the year out here in the Pacific Northwest — I’m really not going to want to chance having them mail me insulin and the GLP-1 agonist that I take — neither one of them are rated for being frozen during transport. My refills were staged in such a way that we should be out of the coldest part of the season by the time it’s time for me to refill either medicine.
If I were still in Florida, I would also cringe at the idea of shipping injectables via mail. They’re typically rated for limited temperature bands for excursion. Florida gets very hot to go with its high humidity. It’ll be 97°F (36.1°C) in the sun, with a feels like temperature of 105°F (40.5°C) just standing in the sun as an organic meat computer. Now add a big box truck with poor thermal controls to the equation (which covers USPS, UPS, and FedEx), and you have vehicles hot enough to liquefy chocolate, wilt flowers, and spoil medicines. And this is how these companies want to ship life-sustaining things like insulin‽
All of this just makes me want to force the decision makers at each of these pharmaceutical benefits management companies to eat a four ounce serving of sugar free gummy bears for every validated report of delivery screw-ups. Let these decision makers feel the suffering to the tune of gastric distress every time someone has to start fighting with their damned company because an important medicine is wandering around in the back of a delivery truck half the country away.
Maybe then, they’ll be willing to listen to the rest of us when we say “This is a bad thing. We want choice, and you should pay them fairly.”
Last evening, I posted a few tweets about a problem with getting one of my prescriptions via mail order through Express Scripts:
The longer story, which doesn’t fit in a few tweets is complex: I ordered a three month supply of my Freestyle Libre 14 day sensors through Express Scripts on the 11th of December, with a message from them showing they’re reaching out to my doc for a write-up of a 90 day run. I had just taken on a refill a couple days prior, and wasn’t scheduled to swap sensors until the 14th of December. That gave me a bit over 16 days to have new sensors in hand, which is plenty of time under typical circumstances.
Two days later (Friday the 13th, no less), in the evening, I get an email from Express Scripts letting me know they’re waiting on my doctor’s office to send over the updated scrip for a 90 day fill. I send a portal message the next morning to my office, and mention that it’s possible that the refill request went to my previous practitioner, who had left the office in the prior month. That way, they should be able to find that and migrate it over. I specifically named the sensor as the requested item for refill in that message.
~ 12 Days of Sensor Time Remain ~
Monday, 16 December hits, and the office acknowledges that they got the message and sent things along to Express Scripts for my sensors.
Tuesday, 17 December lands, and I get a message: “We shipped your order on December 17, 2019.” for a medication starting with F. Express Scripts, of course, obscures the name of the medicine in email by default. I have two prescriptions that begin with an F, and the other one had been filled a month prior, not due for refill for two months. I’m calm and not worried — this package has a UPS tracking number, and should deliver by Christmas. I think nothing of it and don’t log in to the Express Scripts portal.
Wednesday, 18 December sticks its head over the fence. “We’re working on your order,” another email from Express Scripts reads. Wait, what? is my reaction, knowing my refill dates for my other maintenance meds are a week out — I had already received that message. So I log in to their site, and my blood starts to boil.
Somehow, there’s a refill on the 13th of December for the Freestyle Libre READER. The SENSOR KIT has an order date of the 18th of December. I had no emails suggesting they were actually filling the reader, which I really do not need — I have two of them, before this shipment. One is my phone, the other is an actual reader.
Keeping in mind that I check my email in the evening after work, usually, it’s late and I write off my attempt to scream at someone until the next morning.
~ 9 Days of Sensor Time Remain ~
Unusually, I check my email that morning as I wake up, and there’s a rather mollifying message there: “We shipped your order on December 19, 2019.” for a Medication starting with: F*****. I check the app, and it’s the sensors actual this time. I’m still miffed, but there’s still a good chance I’ll get them on time — it’s another UPS shipment. So I’ll check the tracking number in a couple of days, give logistics time to move the package.
~ 6 Days of Sensor Time Remain ~
It’s a lazy Sunday, and I check my email. I find myself pulling the tracking number for UPS out of the email, and growing irritated. The estimated arrival date of this package? 31 December 2019. That’s three days past my sensor swap day. That’s LATE. I bite my tongue, however, because a mote of logic shows up: “Hey. It’s a couple of days until Christmas. It is possible that the package is moving right now, and has not been scanned in transit because of a glut of packages.”
That is what it looked like when I looked at the tracking data, so I decide I’ll wait for the 26th, just in case that’s exactly what’s happened.
~ 63 HOURS of Sensor Time Remain ~
Thursday morning, I check that damn tracking number. No updates, still 31st of December. Now I’m Angry++. I try to call Express Scripts while I’m walking to work. Their IVR is infuriating, and eventually asks me if I’d like a call back as the wait is seven minutes. I select yes — this would give me a chance to finish walking and get out of the sounds of traffic.
Express Scripts is, bluntly, fucking stupid at this point. Their callback system calls from a phone number of ALL ZEROES. How do I know this? My cellular carrier blocked the call as potential spam, showing a number of ALL ZEROES.
Great. Now I have to call back and murder my way through their IVR. I’ll have to do this in a couple of hours… and I do. At this point, I’m voice gating through their system, taking advantage of a few tricks I had discovered and get a human in record time.
This human just hems and haws about — I’m frustrated, but doing a remarkable job of not taking it out on them. This person is just a cog in the great and terrible machine, and isn’t the root of my ire. However, three minutes into the conversation, they earned a prunable branch status by virtue of NOT GETTING THE POINT.
So I cut to the quick on it: Look. I ordered this well in advance. Your company goofed up. My sensor wears out in two days. Your delivery lands several days after that. Can I just go to my local pharmacy and get this thing filled so I’m not out?
This human finally gets it, says yes, get a one-off scrip and have a local pharmacy fill it. They then pork about a bit more, and ask a stupid question. “Can I transfer you to a pharmacist so we can ask what happens if you don’t get your refill in time?”
I’m angryactual at this point, and stop drawing all punches. I can tell you what happens if I don’t get my sensors in thirty seconds. I come out of pocket at about eighty cents a pop to test my blood glucose with strips I have to buy out of my own money. Express Scripts does NOT COVER the cost of the testing strips that are compatible with my glucometer, and as an insulin user, I have to test. And testing three times a day is the average for me on finger sticks. That’s about $2.40 a day in strips alone for every day I have to wait. At this point, you’ve given me the information I need, and I need to get that ball rolling. This is all I need; thank you for your time, good day.
I drop that call, and call my doctor’s office, tell them what’s going on and get them to fax over a fill to my local FredMeyer Pharmacy, figuring that if anyone would have them in stock within the next 24 hours, it would indeed be them. Plus, with their longer hour availability, I would have a chance to get in to the pharmacy and pick this up before it’s too late.
I call FredMeyer that evening and ask if they got the order, and when I could pick it up, and the poor tech had to tell me that insurance is denying the fill.
If you see a smouldering pylon off to the east, that’s the Express Scripts office. They’ve goofed me up on this. They told me to have my office send this over because the mail order isn’t going to arrive on time, I said.
Don’t worry, fam, I gotchu. That’s the short version of what I got back. “Hey, don’t worry. We’re going to call them now to get an override. Can we call you back?”
I get a call back eight minutes later, and was told to swing by in an hour.
I do so, and the tech apologized — they didn’t have two sensors in stock, so I’d need to come back the next day. They offered to text me when the sensors arrive, saying they unpack their pharmaceuticals mid-day. Sure, I’ll take a text, but won’t be in until about 17:30, 18:00 or so.
I’m completely okay with this, because I have a hard arrival time on the board, and it’s a number before sensor depletion time. Thank you, thank you, I’ll come back tomorrow. Buy some groceries, go home, and rest.
Oh, and that reader I didn’t order had arrived.
~ 29 Hours of Sensor Time Remain ~
Friday evening. I hadn’t received a text, but I’m dead set on going to the pharmacy anyway, and if I have to camp out in the pharmacy area until the next morning, at least there’s food and a bathroom, and some furniture. But I was not planning on leaving without sensors, even if I had to ask the cash price and buy one right then.
Different pharmacy tech, and I ask for my prescription. “You don’t have any prescriptions.”
Nope. That wasn’t what I wanted to hear. Nuh-uh. Re-evaluate. Are you certain, I ask her. I was here yesterday, and was told that a pair of Freestyle Libre Sensors were ordered and should’ve arrived on today’s truck. Express Scripts screwed up a mail order, and I have 28, 29 hours left on the one I’m wearing. I really need them.
She checks, and does see the scrip as well as sensors in stock, but also reports that Express Scripts is blocking the fill because of the mail order. I went through this yesterday, and Express Scripts was called for an override to be authorized. Now I’m about to start panicking.
At that point, I’m visibly distressed, feeling like I’m being punished for doing the thing my insurance has mandated, and I just want to cry.
The tech was very comforting. “Hey, don’t panic. Have a seat — we’re going to call them again to get this fixed. We’ll get this taken care of.”
So I sit. And I tweet a bit of acid about Express Scripts, with a very overt thanks to my local FredMeyer Pharmacy.
And ten minutes elapse… with the tech calling me up. They’ve got the refill. There are TWO sensors. I’ll TAKE IT. I thank her and the pharmacist profusely, and take delivery of two units. I now have a backup in case of emergency that I can rotate into the cycle, and I have one for my sensor day.
I’ve never had such an ordeal in getting a prescription, and no-one should ever have to do that much chasing and fighting to get something that they’ve been prescribed.
Express Scripts should feel shame for making this such an arduous task, as well as being rather environmentally unfriendly. Medicines that need refrigeration, as well as equipment that contains lithium-chemistry based batteries should not be REQUIRED to be mailed to the home. I should be allowed to walk into a pharmacy of my own choice and get a three month fill of these. Don’t mandate that I have to use a specific national chain that begins with a W for three month fills — no-one’s paying for my Lyft to get there and back when I have to go late in the evening or on a weekend.
Instead, I have to take delivery of a big styrofoam crate with ice packs inside for two different medicines quarterly, and no, they won’t synchronize the prescriptions to send them all together.
Tell you what, Express Scripts: Honor a prescription for an electric bicycle of my choosing, or pay for medical transportation and I’ll show you cost savings: Every time I can go pick up my own prescriptions in 90 day runs, you don’t spend money on shipping, packaging for shipping, carbon sequestration (because I know big companies like to do that to look carbon neutral), logistics to pack meds, and all that.
By making sure I actually have access to my medicine, it lowers the chance of negative impact to my health.