Late to the party...

My profession is to advise business owners as to the choices of available medical plans for their employee's.

With that said, employers are always complaining about the high cost of health insurance. Why? Most employers pay 80-100% of the cost to cover the employee (ee) and 0% of the cost for the ee to cover his/her dependents.

Since the ee's also have skin in the game, they will also yell about the high cost of health insurance as well.

One of the large drivers of the high cost of medical premiums is drug claims. Carriers get creative about lowering costs and more plans are starting to mandate generic drugs. If carrier "a" can reduce their premiums lower than carrier "b", carrier "a" will sell more policies. Pure capitalism.

If you don't want the generic, then the insurance carrier pays what they would have for the generic towards the brand name. The patient then pays the entire cost difference. Under FDA regs, a generic must legally have the same active ingredients as does the brand name. The only differences are the coating of the pill, the color, the shape, the inert ingredients in the pill, etc.

Put another way, when you buy a car do you pay full MSRP for the car or do you negotiate the price?

Same analogy for prescriptions for the insurance carriers. Why should they pay full MSRP for drugs when they can get the equivalent generic drug at a much lower cost? Trust me, you don't want carriers to pay full MSRP because they will simply "pass through" the higher costs to your employer and to you via higher health insurance premiums.

Every carrier allows an appeals/grievance process. If a person lets say is allergic to an inert ingredient in the generic, he/she can appeal to have the brand name to which they have no allergic reaction, covered.

Something else you may not know, is bringing a drug to the market for a pharmaceutical manufacturer is obscenely expensive. The failure rate is about 9 to 10. So for the one drug that makes it through all the steps under the FDA, nine failed. Should a drug get final FDA approval, the manufacturer is granted a patent on the drug that is usually around 7-12 years. Consequently the manufacturer has a government granted monopoly under which they can charge whatever they want for the drug.

Back to the OP, my gut tells me it was not a CVS issue, but an insurance carrier issue. Granted whomever you talked to at the pharmacy should have been more clear about what was going on. Simply ask CVS what your cost would be for the "old" drug and then again for the "new" drug. Then as long as your doctor is OK with a possible switch, make the decision your own.

As pharmacists, we are constantly pressured by the insurance companies to save them money. Look up PBM's and what are called DIR fees sometime. It is straight up extortion.
^^^^^^^^^
Yep. Educate yourself. PBMs are one reason are drugs are so high. A middle man between you and your doctor. Suddenly, the drug you have been taking for years has a sky high copay because the PBM gets a better deal on another drug.

I didn't read all the responses..

What firm underwrites your Rx benefits? Is it possible the Rx provider (not CVS) reached out to the doctor to ask if a lower cost option had been considered?

OP was lied to about a drug that he takes internally. That is the bottom line.
I would take my business elsewhere after filing a complaint in person with the mngr at the pharmacists, a complaint with the state pharmacy board, and speak to my doctor about contacting me directly about any changes in my medication. Make sure it’s noted in your chart, and the situation that just happened used as an example as to why it’s important that they verify any changes directly with you or a trusted family member.
I think most folks know insurance drives a lot of things these days, but the way this was gone about was WRONG. Someone should be released from their job for lying or forcing an employee to lie. The OP should have simply been told the truth, then he could decide how to proceed.
Now he faces a lack of trust with all future encounters at any pharmacy he visits. That’s a shit way to run a business, ruining it for all the ethical folks out there that have to try and re-earn the trust that should’ve been theirs to begin with.

It’s his body. He should know what’s going into it. Someone just crossed their fingers that he wouldn’t doublecheck, and that’s the asshole that should be fired.

I would bet $100.00 that when the pharmacy submitted your old prescription for payment they got a message back telling them your old medication was no longer on the "preferred" list and asking/demanding that they initiate a change to the preferred drug. They call the doctor and ask for a change (either telling them a lie in the process or having the MD's staff misunderstand the reason for the request). And then they tell you a lie about the doctor initiating the change.

Absent the lies, this process takes place all the time in pharmacies and the insurance companies will have piles of documentation on the safety of the switch for the vast majority of patients. If there are extenuating circumstances that would require the patient to receive the original medication there is a process for the doctor to submit documentation to support the use of that drug. This process is burdensome to the physician, usually take 4 to 6 days for a response, and usually delays the patient getting any meds until resolved.

Currently, retail chain pharmacies are significantly understaffed which will sometimes lead to pharmacists being untruthful as to the reason for the change. In their mind it is easier to lie to the patient and/or doctor and get back to work than to take the time to explain the real reasons for their actions.

Nationally, CVS has the worst reputation among pharmacy chains for understaffing their pharmacies. As mentioned by others HEB has a pretty good reputation.

You have a couple of avenues for complaint. One is to call the regional pharmacy supervisor for that store and complain. You can get this information from the STORE manager (not the pharmacy staff). Many times this will solve the problem and result in some sort discipline for the people involved. You also have the state board of pharmacy. A complaint to them always gets a pharmacist or pharmacies attention.

If they initiated a request as a result of an insurance issue and the physician agreed to change the presription then they most likely acted within the law (I am not conversant with Texas pharmacy regs). BUT lying to you is something that will not be appreciated by the board. By complaining you start an entire investigative process that most pharmacists will do anything to avoid. Even if they are found to have not violated any rule or statute going through the process is almost always a traumatic experience for the pharmacist.

If it were me I would complain to both the CVS PHARMACY management and the board of pharmacy and then find a new pharmacy that will be honest with you.

I am a pharmacist of 43 years who retired a year and a half ago and spent 13 years as a board of pharmacy member and employee of the board. We would regularly see things like this from pharmacist who were afraid of conflict.

There are three components here:
1.) Physician
2.) Pharmacist
3.) Insurance carrier

Either one, two or all should be contacted and queried! It is a financial issue!

CVS arbitrarily making medical decisions for you? Raise a huge stink, because they're probably doing it to other people too.

Also, never trust them again. Take your business elsewhere.

quote:

Originally posted by irreverent:
OP was lied to about a drug that he takes internally. That is the bottom line....

I agree.

There's a variety of capitalistic dynamics here, some honorable, some probably not honorable. But don't lie to the patient.

We use Costco or Publix,

I'd bet the substitution was insurance directed or based on a better contract for a different suppliers of medication.

Just look at the pills in the bottle, I've seen different colored and shaped pills than before when picking up a refill. Clearly the pharmacy obtained it's pills from a different supplier.

It's named the same, works the same, but it's not the same.

As Marc1911 said, I'd bet most Pharmacy staff do this because customers don't question it like they would if the pharmacist said your carrier made the change. Stupid really because it builds mistrust with the pharmacist for lying or hiding the truth even though they had nothing to do with the change.

Most likely it's the PBM that's looking to maximize profit, PBM's don't care about customer loyalty, just profit per script.

I'd look for another pharmacy since you can't trust CVS because of it. You should have been given the option to take the new substitute, or continue on with your previous script and the cost difference being your out of pocket choice.

quote:

Originally posted by bobtheelf:
CVS arbitrarily making medical decisions for you? Raise a huge stink, because they're probably doing it to other people too.

Also, never trust them again. Take your business elsewhere.

Somebody gonna die -- and even then CVS won't listen. I left them (understaffed) and went to Publix. Since we shop there it stands to reason that Rx is there and handy. Techs know us and are more than ready to help with questions. Also, flu shots free AND get a $10 ceretificate.

quote:

Originally posted by Angus the Kid:
Pharmacist says they are in the same family of drugs so I should have no problems.

"should have no problems"
You "shouldn't," but TONS of people do. "Same family" of drugs doesn't mean jack diddly squat. It's a copout. All that means is that they are chemically "similar" and work in "similar ways."

Have you ever met someone who has tried various different medications for the same condition, yet one works better than the others? Chances are the drugs were from the same "family." Theoretically, they "should" work the same, but people are biologically and chemically different. Theory and reality are two different things. Demand that they stick to what was prescribed, and give them hell for the underhanded switch.

On a side note, studies show that in the majority of people and situations, olmesartan medoxomil works better than losartan potassium. So, feel free to tell the lying pharm to shove his/her "should" up his/her rear.

This message has been edited. Last edited by: WingedMedic,

^^^^^^ I tried Olmesartan and I couldn't stand it, the pills smelled like rotten eggs. I just couldn't swallow those nasty things.
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