A, B, C, MS: Rx hard to transfer
If you felt the earth move in January, it may have been UVA employees getting acclimated to a change in their prescription-drug coverage.
Take the case of Lisa Miller, who has multiple sclerosis (MS). Miller gave me a record of her saga, beginning with her attempts to get an injectable MS drug we'll call Drug A. In early January, she claims, she called UVA's new prescription-drug provider, Eckerd Health Services, for a refill. (She prefers to receive her prescriptions by mail.)
Miller reports that she was told the refill was "in the works." When she called back two weeks later to follow up, however, she says she was told that the drug required "pre-authorization" and that she was instructed to contact a special division of Eckerd, which retook the order.
During this same phone call, according to Miller, she also attempted to refill two other prescriptions originally filed with PharmaCare, UVA's previous provider, for what we'll call Drugs B and C. But she says she was told that Eckerd had not obtained the existing prescriptions from PharmaCare, so she "would need to obtain new prescriptions."
This was startling news, because UVA offers a "Frequently Asked Questions" page that claimed that refills of existing mail service prescriptions would be transferred to Eckerd "in early January 2004"– yet Miller was being told that Eckerd had no record.
"I telephoned my physician," Miller continues, "and discovered that he was on vacation. The physician covering for him rewrote the prescriptions, but could only do so for a 30-day supply." She saw her physician on March 11, who wrote "new" prescriptions for Drugs B and C (and faxed a required pre-authorization form for Drug B to Eckerd).
According to Miller, she called on March 23 to see if the prescriptions for Drugs B and C had been filled, and was told, she says, that Drug B required pre-authorization. She explained that a pre-authorization had been submitted. The Eckerd representative agreed to try the prescription again, but was still unsuccessful, she says.
Miller then contacted UVA Health Plan Ombudsman Anne Broccoli, who was able to cut through the bureaucratic jungle and get the prescription filled.
Now, back to Drug A. Miller eventually received a 30-day supply– not the 90-day supply she was used to getting under PharmaCare. "I am sure," she wrote, "that having to reorder every 30 days will be more expensive than [receiving] a 90-day supply, not to mention an inconvenience."
I met with Broccoli, who walked me through the various provisions of Eckerd coverage– which isn't academic for me, as I'm also a UVA employee. And I plead guilty to not having read (or, in some cases, even saved) the information UVA sent about the new coverage.
Miller admits she apparently neglected to read the letter explaining that because MS is one of a group of illnesses that require complex drug regimens, Eckerd will closely monitor her prescription for Drug A. Miller will be assigned to a patient-care coordinator, who, as explained in the unread letter, will contact her "on a regular basis to help with medication compliance and answer any questions."
However, Miller claims she has yet to be contacted by such a person– even though it's been more than three months since the switch-over.
The day after I met with Broccoli, she emailed Miller to say that she had verified that the prescriptions for Drugs B and C "did indeed transfer" from PharmaCare to Eckerd. Three months– and two replacement prescriptions– later, however, that's pretty cold comfort.
Broccoli did have some good news for anyone who, under the new plan, was denied Nexium (a popular but relatively expensive drug for the treatment of such conditions as gastrointestinal reflux disorder): Existing Nexium prescriptions will be grandfathered in throughout 2004.
Do you have a consumer problem or question? Email the Fearless Consumer or write her at Box 4553, Charlottesville 22905.