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Saturday, January 14, 2012

New Year's Day: The Scriptpocalypse Begins

Football has March Madness and Christmas has Black Friday but retail pharmacy has New Year's Day. NYD is a magical time when practically all prescription insurance copays go up, people forget they have a massive deductible or their insurance completely changed and they conveniently have no who/what/when/where/why/how knowledge of their new insurance provider and an ID card has not shown up in their snail mail box. These are the worst of times because pharmacy employees generally become punching bags and the root of all evil when it is no fault of our own.

An extra special addition for 2012 is the fallout from the ESI/Walgreens divorce. I am floating and have witnessed very sad partings of long time patients having to leave because ESI suits are a bunch of money hungry douche bags. Okay, all suits are money hungry douche bags, they can't help what they are... I have even witnessed patients change insurance or start using their spouse's insurance because they are on a first-name basis with their store's employees and are treated like family. Why would you walk away from that if you don't have to?

This all began many many months ago when Walgreens acquired a small chain known as Duane Reade. Mergers require the review of all financials for both companies. In this review Walgreens found that the "best reimbursement rate in the industry" they were getting from ESI was deplorably lower than what DR was getting. After figuring out how much money Wags was losing on each ESI rx they asked for a match of DR reimbursement rates. ESI would not budge and has been bashing Wags ever since.

What ESI has not been letting the public in on is that ESI itself is a corporation. A corporation that has its own set of highly compensated suits, thousands of employees who get insurance, holiday pay, sick pay, retirement plans, etc, and a larger set of shareholders to answer too. The main goal of any corporation is to be as profitable as possible. ESI figured if all of its maintenance rxs are required to go through its own mail order service it no longer becomes a middle man, it becomes "the man" and keeps at least 75% of the money it would have been reimbursing other companies with to itself. I don't hate them for that but I do have a problem with limiting a patient on access to medication when noncompliance is a huge issue. I also have a problem with any company that would limit medication access to the people who defend and die for our freedom. The primary point is any medication therapy no matter how effective and patient specific will fail when the patient is not taking the medication for whatever reason.

Walgreens has found other ways to retain as many patients as possible and I found it funny that Wal-Mart, who has its own pharmacies, dropped ESI so their employees would have access to meds at any pharmacy any time.

Aside from all that nonsense, finding new coverage information for Medicare Part D patients has been an unholy nightmare for all pharmacies......sooooo many plans......sooooo many patients..... I am also going to add "Rx Transfer Specialist" to my resume because I'm super proficient at it now as many of you will be too! So welcome to the Scriptpocalypse and all the joys it brings. I will be celebrating tonight with a gut-busting delicious multi-course dinner with pharmacy friends at The Melting Pot. Yum yum! (***this meal is definitely not recognized as part of any diet unless you are on the "See Food" diet which entails eating everything edible you see)


Drugs and Deli said...

This NYD year has been insane. I think I will be somewhere really warm when next January rolls around.

Anonymous said...

Wal-mart doesn't have ESI, nor has it had ESI in at least the last 2-3 years. Wal-mart currently uses Medco, but ESI may have been the processor (we billed to a self named entity, so i don't remember the actual processor), but the employees have never been limited to just Wal-mart pharmacies, unlike certain other processors (ahem, CVS/Caremark, Cigna, etc). So your point that "I found it funny that Wal-Mart, who has its own pharmacies, dropped ESI so their employees would have access to meds at any pharmacy any time" is moot, because ESI has not in recent years been a provider for Wal-Mart employees.

-A Wal-Mart RPH

Anonymous said...

What I find funny is the grocery store chain in the town where I work tells there customers 3 days on refills- now, some of these are new Tricare customers--with another primary ins- guess what- those rx's have already been transferred back! Let me just say its a Kroger based chain--I will leave the rest to imagination! Antibiotics-2 hours & the lovely state that I am in, 3 of the Medicaid plans are processed through ESI- try telling them that when the closest 24 hour pharmacy that takes it CVS- is more than 30 miles away!

Divamommy said...

love it!!!

Big 'N Tasty RPH said...

I think the card I processed for a Wal-Mart employee was Anthem or one of the other Blue Cross plans processed by ESI.