LIHU‘E — Camilla Crosby’s early experience with her new mail-order prescription-drug plan is causing such stress that trying to get good service and answers to her questions can be hazardous to her health. With her multiple maladies including brain injury
LIHU‘E — Camilla Crosby’s early experience with her new mail-order prescription-drug plan is causing such stress that trying to get good service and answers to her questions can be hazardous to her health.
With her multiple maladies including brain injury and a heart condition, stress can cause seizures and dealing with her new pharmacy in Florida has been stressful, she said.
“It’s been a nightmare,” said Crosby, a federal retiree and disabled senior citizen from Koloa. “It’s been very traumatic.”
Only when she threatened to sue her new pharmacy, informedRx, did she get answers to the questions she had about how best to order and pay for myriad prescriptions for she and her husband, she said.
“I felt harassed,” Crosby said.
It took daily e-mail conversations with the O‘ahu-based informedRx servicing agent just to get any information in writing, she said.
“There was not enough information,” she added.
Crosby’s case is complicated because her federal retiree coverage is the primary provider of prescription-drug coverage for her family, and her husband’s (informedRx) is the secondary coverage.
“There was a lot of confusion about that. They had no idea what they were doing,” said Crosby, whose husband has coverage through the state Hawai‘i Employer-Union Health Benefits Trust Fund.
“We were forced into this. I’m struggling,” said Crosby, adding that she has questioned everything and expects answers from her new pharmacist.
Many of her peers are as confused as she is, she said.
In response to her question about dual coverage, with EUTF being the secondary coverage, O‘ahu-based informedRx representative Nicolle “Nikki” Bassett said in an e-mail to Crosby that participants who have secondary EUTF benefits are not impacted by any of the plan changes.
“The EUTF will be covering the remaining copayment that gets billed to them no matter where you fill your prescriptions,” Bassett wrote.
The EUTF board of directors made what they said is a cost-cutting decision by contracting with the Florida-based informedRx, mandating that many of the EUTF subscribers use the mail-order pharmacy to fill “maintenance” prescriptions for problems like thyroid, diabetes and other illnesses.
“You cannot put money before health,” Crosby said, asking why money is being sent out of the state to the Florida-based company when the economy of Hawai‘i is suffering to the point of public-worker layoffs and furloughs.
InformedRx officials did not response to several e-mail questions by press time.
Jim Williams, EUTF administrator, said the 10-member EUTF board of trustees, made up of state employers and employees, made the mail-order-prescription decision as a cost-cutting measure.
The new plan, he said, lowers copayments for beneficiaries. “Financially it becomes a win-win.”
But not for the local pharmacists, who risk losing between 5 percent and much larger shares of their customers, some of whom are mandated to use the mail-order pharmacy for maintenance medications.
Williams said the EUTF board has received letters of objection to the policy change and letters regarding service issues, which are responded to by informedRx employees. All of that correspondence is reviewed by the EUTF board, he said.
“Every issue and complaint is followed to resolution,” Williams said.
Regarding a specific issue of people getting prescription order or reorder forms even if they might be exempt from the mail-order mandate, Williams said if the system is working right, those exempt from the mail-order mandate (like those active state employees who have primary coverage with another insurer such as HMSA and secondary informedRx coverage) should not be getting those order or reorder forms from informedRx.
There are around 100,000 active and retired state employees covered by the informedRx plan through EUTF, Williams said.
Despite complaints and early problems with the system, Williams said the EUTF board is not considering abandoning the mail-order program. He said some tweaks have been made to the program based on information from informedRx and the EUTF’s benefits consultant.
That does little in the assurance department as far as Crosby is concerned.
She said she was further troubled to learn that someone she doesn’t even know at the pharmacy call center in Minnesota has all of her medical information.
Among her other concerns is what will happen if one or more of her prescriptions now mandated to be delivered via U.S. mail from Florida doesn’t arrive, or arrives late or damaged.
“Then what?”
The informedRx answer is that she or her husband could get “urgent fills” at their local retail pharmacy, in their case Southshore Pharmacy in Koloa, when the retail pharmacy contacts informedRx and requests an “urgent fill override.”
“I recommend to anyone that utilizes mail order that they have a prescription on file at their retail pharmacy as a ‘back-up plan’ just in case you ever find yourself in an urgent situation,” Bassett said in an e-mail response to Crosby.
Patricia “Patty” Kuzen, pharmacist at Southshore Pharmacy, said informedRx has been sending out forms encouraging all EUTF members to begin filling their maintenance prescriptions through their mail-order service, while not indicating that some of the members are exempt from the mail-order program that is mandatory for many EUTF members.
InformedRx has been very vague about who is actually required to use this mandatory mail-order prescription-drug plan, Kuzen said.
Her best advice to all who are having issues with informedRx is to call and ask if they qualify for exemption from the mail-order mandate.
“The local pharmacies are understandably upset about losing a large share of their prescription business to a large mail-order pharmacy in the state of Florida,” Kuzen said.
“But it is more than just a loss of business that is an issue here. Many EUTF members have been customers of a particular local pharmacy so long that they are much more than just ‘a profitable prescription,’” she said.
“Many members have come to know and trust their local pharmacies to the point that close personal relationships have developed. There is no question that ‘knowing your pharmacist’ is a plus as far as quality of care goes,” she added.
“Your relationship with your local pharmacy is a lot more than just a convenience. It is your best chance to be sure that your medications are provided to you with all of the proper pre-screening and care in preparing that you deserve.”
SXC Health Solutions Corp., parent company of informedRx, has announced it has renewed a multi-year contract, to June 30, 2011, for its informedRx PBM business with EUTF.
“This contract extension will allow us to continue to deliver superior PBM (pharmacy benefit manager) services to the Hawai‘i EUTF and its members,” Mark Thierer, SXC president and chief executive officer, said in a press release.
“We earn these types of contract renewals by demonstrating to our customers that we can strategically manage very complex benefit programs that help them to save money and increase the plan options available to their members,” Thierer said.
•Paul C. Curtis, staff writer, can be reached at 245-3681 (ext. 224) or pcurtis@kauaipubco.com.
