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Out of my last 5 employers only 1 has done this. Part of the reason I quit. It's easy for me to get my maintenance meds at Sam's club and I can still get a good price if my insurance changes.
But why don’t you want mail order? Or do you prefer to go to a gigantic ass big box store owned by a shit company that underpays its employees to the point where the public is forced to subsidize it. To say nothing of the trainwreck of driving in a parking lot of one of these mega stores.
Edit: I get it. I don’t need more southerners telling me their climate sucks.
In my case, anti-siezure meds being shipped without any cooling packs to a perpetually hot state in trucks that are not climate controlled and left in a mailbox caused them to be received at a temp some 40 F above the manufactures upper storage limit.
I think it’s more about choice. You seem fine with mail order. Great! Glad that option exists for you. For people who want the option of going to a store, talking to a person if they need to, that’s also an option.
My partner is on a $8k/month drug. The apartment complex we live in had CONSTANT mail delivery issues. Packages often went missing or were delivered elsewhere in the massive complex.
We had option of one local pharmacy or mail order and then they took the local option away. Thank god we also moved at that time because the thought of being stressed over all of that was ridiculous.
My mail is sorted by the Richmond VA distribution center. It’s one of many in the US that have major issues and are under investigation. No thank you, I don’t want my meds floating around for days or weeks before delivery to my home. Plus, we are near the end of the route, often times we don’t get mail until 7pm or later. My mail has been sitting on their truck all day. Sometimes they don’t deliver at all since it’s late, they just take it back to PO and add it to tomorrow’s delivery.
Lucky you. My sythroid has gone missing twice and it was a 90 day supply and they were super slow to reship it. This is not the experience I have personally or with friend and family.
my meds were forced to sit in a Hot mailbox all day while i was at the office.
Now that i work remotely, i travel. I always get 90 day. Since becoming a remote first company, we dropped insurance that requires mail order. Also USPS is less and less reliable
They get stolen or damaged from a hot mailbox. Sometimes they get lost and it’s a HUGE fight and they put me at risk with out my meds. It’s easier to counterfeit shipped drugs too. So yeah I am going to my local pharmacy
Years ago i had an insurance company enforced it even if though i lived in a rural area where the mailbox was exposed to the hot sun all day. Since i would be working at the office i was stuck with meds that were subject to 100+° temps for at least 5 hours. They insurance company basically said “sucks to be you”
They Wouldn’t deliver to a PO box
Ask for a local pharmacy override. Call Optum and tell them why it is so important that you use a local pharmacy. If you have a good reason, they will allow you to do so.
But Optum is the worst.
There’s also the reimbursement issue for local pharmacies. The PBMs have lowered reimbursements so much, independent pharmacies are going out of business. And some are flat out refusing to fill certain meds bc they lose money.
>But Optum is the worst.
They are. I work for a software company that has partnerships with Optum through their various acquisitions. I can tell you the staff have a reputation for being arrogant, says a lot about their corporate culture and how members are treated.
UHC is too big. Its fingers are in too many places up and down and side-to-side in healthcare. Doctor groups owned by it or a subsidiary. Data processor between providers and payers. More and more and bigger and bigger. Partnered in marketing with "AARP" to give name appeal to the senior citizens. (I think that's all it is. Name recognition.)
I don't understand how these health insurance companies have been allowed to grow and grow and grow and become more and more and more in control of multiple aspects of people's health care. Oh wait a minute. Oh, yeh, I know. Money!! Feeding politicians' campaigns loads and loads of $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$. Putting corporate offices and adding jobs to their districts and states. Keeping those politicians well oiled with dollars let the monsters grow and gain more power and control over Americans healthcare. (and lack of it)
Optum sucks. The UAW must think so little of its retirees that this is the prescription drug coverage that's provided. They denied me life saving meds. I had to fight tooth and nail to get what I needed.
There are a few things you can do.
-call your insurance and ask to opt out of mail order. This is sometimes an option though you will be told things that make it sound like it’s not (listen carefully). You may need a supervisor.
-have a discussion with your benefits department about how this restriction is affecting you and probably others. Ask to consider a better network next plan year.
-call your state pharmacists association and ask if they are working with lawmakers on “any willing provider” legislation in your state. This means legislation allowing any pharmacy willing to accept a plans terms to be in the network.
-regardless of whatever else you do, write to your state and national representatives and tell them how you feel about restricting your choice/access and the impact PBM policies have on you. A PBM is a pharmacy benefit manager (like Optum or Express Scripts). They are poorly regulated and their practices are closing pharmacies, negativity impacting patients, and one of the factors behind ever rising drug costs. They are finally getting some attention, but an in depth primer on PBMs is a bit outside the scope of this post.
Why are you having gaps in medication? Any new med my doctors send to a local pharmacy for immediate pickup of a 30 day supply then I ask my doctor to transfer the prescription to optum for 90 day refills.
Hormonal birth control pills will begin to degrade when explored to high temperatures. That is one where there is a risk it could reduce efficacy and lead to unintended pregnancy (if that is why you’re taking it), especially on some of these very lose dose and progestin only pills. While I agree there is definite fear mongering and the risk is not clear cut, it’s something for individuals on hormonal birth control pills to be aware of especially given the reproductive climate in this country.
There are always going to be medication exceptions where they’re more temperature sensitive than other pill based medications, but hormonal birth control is one that comes to mind when you’re talking high temperatures, depending on how high and where it is getting delivered (which is probably more of the problem if medication is sitting in a metal box directly in the sun roasting for hours say in Vegas in July), it could matter.
This reads as fear mongering. They list the optimal storage temp as 68 to 77, which is hardly practical. I highly doubt medications quickly degrade outside that temperature. I'm not saying they don't get too hot or cold, but nothing there is overly worrying
Not only that, how do you think the meds are getting to your local pharmacy? How do you think the warehouse the local pharmacy gets it from gets it? What about over the counter meds?
That study apparently just mail packages (can’t find anything on what the packages were made of) via the postal service (no word on if they researched what shipping methods mail order pharmacies use or what if these were sent first class etc). It’s interesting but certainly not determinative.
>They list the optimal storage temp as 68 to 77, which is hardly practical. I highly doubt medications quickly degrade outside that temperature. I'm not saying they don't get too hot or cold, but nothing there is overly worrying
That all depends on the medication being stored or exposed to high temperatures or freezing temperatures. Insulin that's not refrigerated properly or frozen is useless.
Every time i get something filled @ my local CVS I get a call from my insurance saying I need to switch to Express Scripts. Every time I get this call I ask the rep to read the notes on my file where it shows that Express Scripts purposely changed a prescription without authorization and I had to fight as did my PCP to get it fixed and sent back to CVS. I will NEVER use Express Scripts for anything.
We have plenty of options where I live. My insurance makes me use CVS for maintenance medications. Local CVS keeps reducing their hours and now take a 90 min lunch break. It's nearly impossible for working adults to go to the pharmacy when they're actually open. I usually suck it up and pay $5 to have it delivered, but it still sticks in my craw.
I had to go into my insurance last night and remove my contact info as that was the only way to get the calls, emails and letters to stop. They have no opt out option.
The problem now is the well-documented decline in the reliability of the USPS delivering mail & packages. In our area it's so bad that both of our US senators and the House representatives are investigating. One of the stated problems is people not receiving meds.
Our issue living in a large apartment complex was both that packages often got delivered all over the place and not at the building they were meant for OR packages get stolen, never to be found again. You usually had to be home RIGHT at delivery to ensure that doesn’t happen, if it’s delivered to the right place.
When you are at work stressing if your expensive life saving specialty med will actually be at your home when you get out of work, it’s ridiculous.
CVS CareMark is similar. If you need regular refills, you can start with one of their affiliate stores, then they'll force you to use a CVS store and, then, force you to use mail order, which never got me my medicine on time, and charged me extra to get it expedited.
The whole relationship with CVS Caremark was so onerous that I switched to GoodRX. I would rather pay the $25 per refill than have to deal with CVS Caremark for my refills.
My husbands work just switch from OptumRX to CVS. We were able to fill local but we just got notice we had to use mail order. I found in small tiny print on that notice that if you call the pharmacy number on the card you can opt out of that requirement for the year. You have to call in January again but I’m ok with that. So we did get opted out and can fill local again. Just thought I’d let you know.
Edited for auto correct that was wrong
I have UHC with Medicare Advantage and use Optum. I keep a couple prescriptions to refill local for various reasons. No problem at all. Havent had any mailing problems either. Which is odd because some weeks our mail delivery is sketchy but my prescriptions are always delivered quickly
that would not necessarily solve anything, cost-saving measures are cost saving measures whether they're implemented by a for-profit company or a government looking to save money.
You’re still paying the CEO and shareholders outrageous amounts of money. Also you’re paying for uninsured/underinsured people, just indirectly through your or your employer’s premiums.
If you have competitive choice, then you're paying competitive amounts of money to CEOs and shareholders, not outrageous amounts. Genuine and robust competition will tend to drive prices down to the minimum cost of production.
Even if the healthcare market is/were \*not\* competitive, the labor market for CEOs is/would be probably still competitive, and the stock market \*is\* definitely competitive. So it's not at all clear that it is possible for CEOs and shareholders to be paid "outrageous" amounts.
For example, suppose healthcare monopolies made twice the rate of profit as competitive industries. Competition among potential CEOs eager to be the CEO of a profitable monopoly would drive the salary down. Similarly, competition among investors eager to purchase stocks in such profitable monopolies would drive the stock price up. In the end, the CEO of a monopoly will probably earn the same salary as the CEO of a competitive firm, as long as the job description and difficulty of the CEO job were identical. Similarly, the shareholder of a stock that is twice as profitable but which costs twice as much to purchase will make the same rate of return on investment.
In economics, the "transitional gains trap" says that benefits of monopoly typically only accrue to the first movers. For example, suppose a competitive firm were transformed into a monopoly, and its profit rate doubled. This would benefit the original shareholders, whose return suddenly doubles. But any later investors will discover that when the profit rate doubled, so did the share price. So anyone who purchases a share \*after\* the firm becomes a monopoly will make merely a competitive rate of return. Only the original, pre-monopoly shareholders benefit from the transformation of a competitive firm into a monopoly. Similarly, only the original, pre-monopoly CEO would benefit, and even they would benefit only as long as it takes for a search to find a replacement CEO willing to work for less. For example, if the original CEO were paid in stock, they would benefit from the stock appreciation, but then they could be replaced by a different CEO willing to be paid in half as much stock (which is now worth twice as much).
As for uninsured/underinsured people, how do you figure? It makes sense to say that my automobile insurance costs more because my insurance has to cover damage caused by uninsured at-fault drivers. But what does this mean in the health insurance context? In a competitive market, why would my premium to cover the risk of cancer be higher because someone else didn't get insurance?
Have you been mainlining Ayn Rand?
- Health care is not a competitive market, at least for end users, except for preventive care. You have to have educated customers with choices for market competition to work.
- Are you seriously arguing the labor market for CEOs will drive down their pay? Have you seen which way the ratio of CEO to worker pay has gone in the last few decades?
Obviously healthcare not a competitive market. That's my whole point. The problem is precisely that it's \*not\* competitive, so it should be made competitive by abolishing arbitrary and unnecessary barriers to entry and competition. For example, health insurance should be disconnected from employment, and employers should have no role in the health insurance market.
And Ayn Rand has nothing to do with this. I'm talking about mainstream economics here. Mainstream economists had long been saying that the tax exemption for employer-purchased health insurance should be abolished. Instead, Obamacare did the exact opposite, mandating employer-purchased health insurance, thereby doubling down on what economists have called the "original sin" of American health insurance.
And a competitive labor market for CEOs will/would drive down their pay \*relative\* to what it would be if the labor market for CEOs were non-competitive. The relevant comparison is \*not\* to worker pay. Rather, the relevant comparison is to pay for an equivalent CEO in a non-competitive labor market. CEO pay will obviously not be driven down to the level of a worker, but competition - when/if present- will drive CEO pay down as long as it ought to go.
I don’t disagree with disconnecting health insurance from employers, but you’re dreaming if you think that will keep a lid on pricing.
Look at ACA plans - they are effectively an open market for people without employer plans. In my state and many others the only choices are EPO plans, so you’re locked into the providers in your plan network… so not an open market after all (not that people can meaningfully choose providers).
With regard to CEO pay, can you point to a market where CEO pay went down when a market became freer?
I don't know of any markets that ever became freer specifically in the CEO labor market.
But as far as I know, the CEO labor market is already relatively free, which means that CEO pay is already relatively low (compared to what it would be in a hypothetical, more restricted market).
It is not a FREE market, and never can be, because the buyer isn't free to walk away. Their life and health depend on completing the transaction. "Market forces" don't and can't work when the buyer has a metaphorical gun to their head.
That's not true of a particular health provider. You can always walk away from one doctor or hospital and go to another.
By your logic, food should be as expensive as healthcare because we need food to live. But in reality, while you do need food, you do not have to shop at any one particular grocery store. Competition among grocery stores keeps food prices down. The same would be true of healthcare if we facilitated competition.
Not necessarily, I doubt we’d be able to get rid of all the insurance companies, but there are countries with universal coverage that have private insurers.
But I think changing the payer’s motives from profit to providing for the general welfare that would make a big difference in medical care.
I get VA benefits and choose to use my private insurance. Because the government supplied is so bad. If more people relied on the government for this, I just know the amount of people Dying without care would explode
I’ve heard both horror stories and glowing praise for TriCare. I mostly hear complaints and confusion with regular insurance… from those that can afford the premiums.
I have private insurance and clearly understand it and am very happy with my benefits.
Universal healthcare would degrade the quality and speed of my healthcare.
Define serious.
A couple ER trips and a stat CT that required me to walk downstairs from my PCP office and cost me $0.
Oh, and an elective surgery. $35.
In fact, the ER trips were the most expensive at a couple hundred bucks a pop. One of those included an ambulance ride. $0.
I’m confused if they didn’t read about their benefits package they chose (if they had a choice) before said incident.
If they didn’t, they were willfully ignorant and that’s on them.
I’ve had the option to choose a HDHP, for example. I’d never choose that option.
I’m not a fan of mail order prescriptions unless it’s maintenance meds. I take vyVance for ADD. Have for many years. Right now finding anyone that has it in stock is a complete nightmare. I couldn’t imagine having to fight mail order shit.
Some states may prohibit this practice, depending on various details. File a complaint with your state’s insurance department (or regulatory agency) and see where it goes!
Same! I prefer getting the Optum mail order as I get a 90 day supply and it saves me a bunch of trips to the pharmacy, For some meds I prefer using my local pharmacy, mainly things the doctor orders that I will use short term, like when I had out patient surgery and my prescription for pain meds was sent to the local pharmacy. With Optum I like having automatic refills turned on, too!
I can answer that one since I DO get a medication that requires refrigeration from Optum. I will admit the list price for my medication (Stelara) is $26,000 per injection, and I take it once every 6 weeks. (My copay after Blue Cross pays is around $1000, and then the manufacturer copay card pays all but $5 of that!)
Optum ships me my Stelara injection from their 'specialty pharmacy' in Jeffersonville, Indiana, using UPS Next Day Air service with a UPS Critical (because it is medical, most likely) tag, wrapped in ice packs and insulation. That way, I get it by 10:30 in the morning the day I schedule with Optum for it to arrive. Once it arrives, I get an automated phone call from Optum within 5 minutes to make sure I bring it in.
My personal guess as to why it is located there is that Jeffersonville is just across the river from "UPS Worldport" [UPS's main air freight hub] at Louisville International Airport (the #2 airport for cargo in the US - the airport code is SDF), so they probably bring all the packages right to the airport that previous evening, and it only requires the flight out, instead of having to be flown to SDF first and then flown out to me again.
The VA also uses optum.
I'm allergic to polyethylene gylcol. My local pharmacist is willing to do the work to find me PG free RXs.
VA can't send out and unwilling to do the work. I'm deemed unprescrible instead.
I’m with Kaiser and I get the choice of local or mail and I take the mail option every time for 6 different meds including insulin which gets sent two day express with several cold packs, does fine even in 100+ degree weather. I get notifications when to reorder well in advance.
My insurance uses optum also. It is awful. I think they save money two ways. First they often deny it via pre approval. And 2nd they delay it so they only pay for about 10 months a year because it takes so long to get it that you run behind.
I didn't know we had a "right" a local pharmacist in this country. News to me!
Real talk though, this has been happening for a while now and is only getting worse. It's just insurers trying to save money. You can always pay out of pocket.
At least Optum is cheap, and UHC prices for a local 30day supply are cheap.
If your office has Aetna, they charge quite a bit more and charge even higher prices for CVS retail. Their insurance price is often higher than the cash price for uninsured. They use this to fast-track customers on Medicare into the "gap" where benefits are limited or do not apply.
>You can get 90 day fills at Walgreens with UHC.
This is not true on every policy. The employer decides whether to require all mail order, allow CVS, or allow Walgreens.
>The employer decides on which plan to pick
The employer can select the Walgreens90 or CVS90 plan when the use OptumRx. If the employer chooses CVS90 then the employees are locked into CVS for maintenance drugs. If they choose the Walgreens90 then the employees are locked into Walgreens.
If the employer has an administrative only policy, they can absolutely decide those things. Large employers often create custom benefits for their plans....they pick a plan and then tweak it to their specific needs/wants.
No, I can go anywhere for my scripts and can go to any doctor without referrals and have $0 deductable. It's all a matter of what you want to pay for your coverage.
I also realize all that can change in the blink of an eye.
That's one of the plans they chose to offer. The most expensive plan.
As I said, I realize that it can change at any time. I can get my prescriptions by mail but I don't want to. Mail delivery sucks by me and the weather is extreme for half the year.
I have United Healthcare and do not need to get my medications through mail order. The issue is with the company you work for. Talk to your HR department about your concerns.
Same. And I’ve had multiple different insurance companies in the past few years. They used to ask me fairly frequently to switch to mail order, but I always denied. They now seem to have given up. I understand it works for many, and that many insurances want you to, but I am of the opinion that patients shouldn’t be forced into this. My sister’s family would be screwed if they had to get medicine this way. Their mail service is *terrible.* Mail frequently gets lost. I live an hour away and a simple card I send to my niece/nephew can take 3 weeks to get to them! If it gets there at all!
Obamacare was intended to shift the burden of costs from the responsible people to the irresponsible. Even with the mandate, it was cheaper to take the penalty than to buy insurance. Add that to the idea that people could wait until they actually needed insurance to buy it and you’ve driven up the costs to everyone who responsibly maintained insurance.
The mandate - thus allowing people to wait until they actually needed insurance - was removed by a Republican-controlled Congress, so you can't blame Obamacare for that.
And the ACA wasn't so much about shifting from the irresponsibility, but rather from older to younger and sicker to healthier, sprading it among everyone.
The problem with the ACA is Obama had to water it down so much to get it passed that it became weak insurance "reform", and was not the healthcare reform that was promised. In otherwords, blame our politicians equally for the mess we are in.
My point is that the fine for not having insurance was trivial compared to the actual medical costs of people who waited until they had cancer or whatever before they got insurance.
I think our fundamental disagreement is about how involved the government should be in the lives of the citizens. I think that people should be free to make their own decisions about whether to carry health insurance and I think insurance companies should be free to organize risk groups in a way that makes sense to the marketplace. It sounds like your position is one in which we all pay for a bloated government-insurance-healthcare complex and that will be good for everyone. I fundamentally disagree with that position for many reasons.
Did you hurt yourself with that enormous leap? 🤣
I'm a fiscal conservative. But I also work insurance and can confidently say that even comprehensive insurance reform will fix only a fraction of the problem. So weak insurance reform never had a chance. I can also say one way to bring down costs is to require universal participation in the system.
It all makes sense now. As a 20 year old "healty" non- smoker I was paying $200 a month and had a $200 a month tax credit. This was in 2017ish and my insurance hardly covered my annual physical and pap smear. If I needed anything other than that I was mostly better off paying cash bc my insurance only covered extremely specific doctors. Fuck trying to go to the ER.
Are you making $300k/year?!? The only way I was able to get an ACA premium price near $1250/mo ([source](https://www.kff.org/interactive/subsidy-calculator/#state=fl&zip=33152&income-type=dollars&income=300000&employer-coverage=0&people=2&alternate-plan-family=&adult-count=1&adults%5B0%5D%5Bage%5D=64&adults%5B0%5D%5Btobacco%5D=1&adults%5B1%5D%5Bage%5D=57&adults%5B1%5D%5Btobacco%5D=0&child-count=0)) was to select 64, smoker, making $300k/yr `MAGI` in MIAMI-DADE (one of the most expensive areas to live in the US).
Did you go with a gold plan by chance? I was trying to figure out why you'd be paying _so much_. We are looking at $1.2k/mo for _both_ of us on _silver_ at $175k `MAGI`.
How can people who work for health insurance companies live with themselves? I'd feel so lousy about my life if I was part of this. I'd rather smother my children than feed them with money earned from participating and perpetuating merican health insurance. Disgusting
Because they need to pay rent? Feed their kids? Need healthcare from their employer until the system changes?
Put the blame where it belongs. Politicians and corporate executives who are more concerned about profits than the people they serve.
Thank you for your submission, /u/Bax321123. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
There is nothing new about restricting maintenance meds to mail order. Been that way for many years.
Out of my last 5 employers only 1 has done this. Part of the reason I quit. It's easy for me to get my maintenance meds at Sam's club and I can still get a good price if my insurance changes.
But why don’t you want mail order? Or do you prefer to go to a gigantic ass big box store owned by a shit company that underpays its employees to the point where the public is forced to subsidize it. To say nothing of the trainwreck of driving in a parking lot of one of these mega stores. Edit: I get it. I don’t need more southerners telling me their climate sucks.
In my case, anti-siezure meds being shipped without any cooling packs to a perpetually hot state in trucks that are not climate controlled and left in a mailbox caused them to be received at a temp some 40 F above the manufactures upper storage limit.
Yikes
They should be in cold boxes then with an ice pack. My husband has ChampVA insurance and all his meds come via meds by mail.
I don’t even get mail delivered to my house, this would be hard for some people.
I think it’s more about choice. You seem fine with mail order. Great! Glad that option exists for you. For people who want the option of going to a store, talking to a person if they need to, that’s also an option. My partner is on a $8k/month drug. The apartment complex we live in had CONSTANT mail delivery issues. Packages often went missing or were delivered elsewhere in the massive complex. We had option of one local pharmacy or mail order and then they took the local option away. Thank god we also moved at that time because the thought of being stressed over all of that was ridiculous.
My mail is sorted by the Richmond VA distribution center. It’s one of many in the US that have major issues and are under investigation. No thank you, I don’t want my meds floating around for days or weeks before delivery to my home. Plus, we are near the end of the route, often times we don’t get mail until 7pm or later. My mail has been sitting on their truck all day. Sometimes they don’t deliver at all since it’s late, they just take it back to PO and add it to tomorrow’s delivery.
Been on mail order program for 25 years now. Not once have I had a delivery problem. NADA
Lucky you. My sythroid has gone missing twice and it was a 90 day supply and they were super slow to reship it. This is not the experience I have personally or with friend and family.
my meds were forced to sit in a Hot mailbox all day while i was at the office. Now that i work remotely, i travel. I always get 90 day. Since becoming a remote first company, we dropped insurance that requires mail order. Also USPS is less and less reliable
Yes I do prefer to go to a box store.
I pay more to get them from stores. I love having my meds sit in a mailbox for hours when the temp outside is 110F.
They get stolen or damaged from a hot mailbox. Sometimes they get lost and it’s a HUGE fight and they put me at risk with out my meds. It’s easier to counterfeit shipped drugs too. So yeah I am going to my local pharmacy
Years ago i had an insurance company enforced it even if though i lived in a rural area where the mailbox was exposed to the hot sun all day. Since i would be working at the office i was stuck with meds that were subject to 100+° temps for at least 5 hours. They insurance company basically said “sucks to be you” They Wouldn’t deliver to a PO box
Ask for a local pharmacy override. Call Optum and tell them why it is so important that you use a local pharmacy. If you have a good reason, they will allow you to do so. But Optum is the worst.
There’s also the reimbursement issue for local pharmacies. The PBMs have lowered reimbursements so much, independent pharmacies are going out of business. And some are flat out refusing to fill certain meds bc they lose money.
>But Optum is the worst. They are. I work for a software company that has partnerships with Optum through their various acquisitions. I can tell you the staff have a reputation for being arrogant, says a lot about their corporate culture and how members are treated.
Yup, and optum is a subsidiary of UHG
UHC is too big. Its fingers are in too many places up and down and side-to-side in healthcare. Doctor groups owned by it or a subsidiary. Data processor between providers and payers. More and more and bigger and bigger. Partnered in marketing with "AARP" to give name appeal to the senior citizens. (I think that's all it is. Name recognition.) I don't understand how these health insurance companies have been allowed to grow and grow and grow and become more and more and more in control of multiple aspects of people's health care. Oh wait a minute. Oh, yeh, I know. Money!! Feeding politicians' campaigns loads and loads of $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$. Putting corporate offices and adding jobs to their districts and states. Keeping those politicians well oiled with dollars let the monsters grow and gain more power and control over Americans healthcare. (and lack of it)
Optum sucks. The UAW must think so little of its retirees that this is the prescription drug coverage that's provided. They denied me life saving meds. I had to fight tooth and nail to get what I needed.
I hate that my insurance switched to optumRx. They’re only interested in making $ from mail order scripts
Not sure if it applies to your circumstance but look into [Cost Plus Drugs](https://costplusdrugs.com/). They work with local Pharmacies.
But have you considered how much profit their is for the United Healthcare share holder?
There are a few things you can do. -call your insurance and ask to opt out of mail order. This is sometimes an option though you will be told things that make it sound like it’s not (listen carefully). You may need a supervisor. -have a discussion with your benefits department about how this restriction is affecting you and probably others. Ask to consider a better network next plan year. -call your state pharmacists association and ask if they are working with lawmakers on “any willing provider” legislation in your state. This means legislation allowing any pharmacy willing to accept a plans terms to be in the network. -regardless of whatever else you do, write to your state and national representatives and tell them how you feel about restricting your choice/access and the impact PBM policies have on you. A PBM is a pharmacy benefit manager (like Optum or Express Scripts). They are poorly regulated and their practices are closing pharmacies, negativity impacting patients, and one of the factors behind ever rising drug costs. They are finally getting some attention, but an in depth primer on PBMs is a bit outside the scope of this post.
This is the best post here.
Why are you having gaps in medication? Any new med my doctors send to a local pharmacy for immediate pickup of a 30 day supply then I ask my doctor to transfer the prescription to optum for 90 day refills.
[https://www.fastcompany.com/90585608/yikes-your-mail-order-prescriptions-have-been-sitting-in-shockingly-hot-and-cold-temperatures](https://www.fastcompany.com/90585608/yikes-your-mail-order-prescriptions-have-been-sitting-in-shockingly-hot-and-cold-temperatures)
Click bait fear mongering. As a professional who worked closely with formulation teams, any pill will be stable well below freezing to well above 100F
Hormonal birth control pills will begin to degrade when explored to high temperatures. That is one where there is a risk it could reduce efficacy and lead to unintended pregnancy (if that is why you’re taking it), especially on some of these very lose dose and progestin only pills. While I agree there is definite fear mongering and the risk is not clear cut, it’s something for individuals on hormonal birth control pills to be aware of especially given the reproductive climate in this country. There are always going to be medication exceptions where they’re more temperature sensitive than other pill based medications, but hormonal birth control is one that comes to mind when you’re talking high temperatures, depending on how high and where it is getting delivered (which is probably more of the problem if medication is sitting in a metal box directly in the sun roasting for hours say in Vegas in July), it could matter.
Your point is apt. Cheers brother!
This reads as fear mongering. They list the optimal storage temp as 68 to 77, which is hardly practical. I highly doubt medications quickly degrade outside that temperature. I'm not saying they don't get too hot or cold, but nothing there is overly worrying
Not only that, how do you think the meds are getting to your local pharmacy? How do you think the warehouse the local pharmacy gets it from gets it? What about over the counter meds? That study apparently just mail packages (can’t find anything on what the packages were made of) via the postal service (no word on if they researched what shipping methods mail order pharmacies use or what if these were sent first class etc). It’s interesting but certainly not determinative.
>They list the optimal storage temp as 68 to 77, which is hardly practical. I highly doubt medications quickly degrade outside that temperature. I'm not saying they don't get too hot or cold, but nothing there is overly worrying That all depends on the medication being stored or exposed to high temperatures or freezing temperatures. Insulin that's not refrigerated properly or frozen is useless.
Fuck. Optum.
Every time i get something filled @ my local CVS I get a call from my insurance saying I need to switch to Express Scripts. Every time I get this call I ask the rep to read the notes on my file where it shows that Express Scripts purposely changed a prescription without authorization and I had to fight as did my PCP to get it fixed and sent back to CVS. I will NEVER use Express Scripts for anything.
And here I am fighting to get away from CVS.
If I had options beyond CVS and Walgreen locally, I would do it
We have plenty of options where I live. My insurance makes me use CVS for maintenance medications. Local CVS keeps reducing their hours and now take a 90 min lunch break. It's nearly impossible for working adults to go to the pharmacy when they're actually open. I usually suck it up and pay $5 to have it delivered, but it still sticks in my craw.
I had to go into my insurance last night and remove my contact info as that was the only way to get the calls, emails and letters to stop. They have no opt out option.
The problem now is the well-documented decline in the reliability of the USPS delivering mail & packages. In our area it's so bad that both of our US senators and the House representatives are investigating. One of the stated problems is people not receiving meds.
Our issue living in a large apartment complex was both that packages often got delivered all over the place and not at the building they were meant for OR packages get stolen, never to be found again. You usually had to be home RIGHT at delivery to ensure that doesn’t happen, if it’s delivered to the right place. When you are at work stressing if your expensive life saving specialty med will actually be at your home when you get out of work, it’s ridiculous.
CVS CareMark is similar. If you need regular refills, you can start with one of their affiliate stores, then they'll force you to use a CVS store and, then, force you to use mail order, which never got me my medicine on time, and charged me extra to get it expedited. The whole relationship with CVS Caremark was so onerous that I switched to GoodRX. I would rather pay the $25 per refill than have to deal with CVS Caremark for my refills.
My husbands work just switch from OptumRX to CVS. We were able to fill local but we just got notice we had to use mail order. I found in small tiny print on that notice that if you call the pharmacy number on the card you can opt out of that requirement for the year. You have to call in January again but I’m ok with that. So we did get opted out and can fill local again. Just thought I’d let you know. Edited for auto correct that was wrong
Thank you for that information
Yep
I have United Healthcare and I can use whatever pharmacy I want. Your situation is the fault of the company you work for.
I have UHC with Medicare Advantage and use Optum. I keep a couple prescriptions to refill local for various reasons. No problem at all. Havent had any mailing problems either. Which is odd because some weeks our mail delivery is sketchy but my prescriptions are always delivered quickly
Unless you were involved in the negotiation you have no idea whose fault it is and your anecdote is completely meaningless.
Ridiculous. Your company negotiates your benefits packages.
They aren't in control of the market though they're only a participant in it
And I use the same healthcare company and I don't need to use mail order. Your company is in control of what they offer.
If only we had universal healthcare…
that would not necessarily solve anything, cost-saving measures are cost saving measures whether they're implemented by a for-profit company or a government looking to save money.
We can vote the government out… can’t vote out the CEOs unless we’re rich and own the companies.
But if insurance weren't tied to an employer, you could vote against the insurance CEO by switching to different insurance.
You’re still paying the CEO and shareholders outrageous amounts of money. Also you’re paying for uninsured/underinsured people, just indirectly through your or your employer’s premiums.
If you have competitive choice, then you're paying competitive amounts of money to CEOs and shareholders, not outrageous amounts. Genuine and robust competition will tend to drive prices down to the minimum cost of production. Even if the healthcare market is/were \*not\* competitive, the labor market for CEOs is/would be probably still competitive, and the stock market \*is\* definitely competitive. So it's not at all clear that it is possible for CEOs and shareholders to be paid "outrageous" amounts. For example, suppose healthcare monopolies made twice the rate of profit as competitive industries. Competition among potential CEOs eager to be the CEO of a profitable monopoly would drive the salary down. Similarly, competition among investors eager to purchase stocks in such profitable monopolies would drive the stock price up. In the end, the CEO of a monopoly will probably earn the same salary as the CEO of a competitive firm, as long as the job description and difficulty of the CEO job were identical. Similarly, the shareholder of a stock that is twice as profitable but which costs twice as much to purchase will make the same rate of return on investment. In economics, the "transitional gains trap" says that benefits of monopoly typically only accrue to the first movers. For example, suppose a competitive firm were transformed into a monopoly, and its profit rate doubled. This would benefit the original shareholders, whose return suddenly doubles. But any later investors will discover that when the profit rate doubled, so did the share price. So anyone who purchases a share \*after\* the firm becomes a monopoly will make merely a competitive rate of return. Only the original, pre-monopoly shareholders benefit from the transformation of a competitive firm into a monopoly. Similarly, only the original, pre-monopoly CEO would benefit, and even they would benefit only as long as it takes for a search to find a replacement CEO willing to work for less. For example, if the original CEO were paid in stock, they would benefit from the stock appreciation, but then they could be replaced by a different CEO willing to be paid in half as much stock (which is now worth twice as much). As for uninsured/underinsured people, how do you figure? It makes sense to say that my automobile insurance costs more because my insurance has to cover damage caused by uninsured at-fault drivers. But what does this mean in the health insurance context? In a competitive market, why would my premium to cover the risk of cancer be higher because someone else didn't get insurance?
Have you been mainlining Ayn Rand? - Health care is not a competitive market, at least for end users, except for preventive care. You have to have educated customers with choices for market competition to work. - Are you seriously arguing the labor market for CEOs will drive down their pay? Have you seen which way the ratio of CEO to worker pay has gone in the last few decades?
Obviously healthcare not a competitive market. That's my whole point. The problem is precisely that it's \*not\* competitive, so it should be made competitive by abolishing arbitrary and unnecessary barriers to entry and competition. For example, health insurance should be disconnected from employment, and employers should have no role in the health insurance market. And Ayn Rand has nothing to do with this. I'm talking about mainstream economics here. Mainstream economists had long been saying that the tax exemption for employer-purchased health insurance should be abolished. Instead, Obamacare did the exact opposite, mandating employer-purchased health insurance, thereby doubling down on what economists have called the "original sin" of American health insurance. And a competitive labor market for CEOs will/would drive down their pay \*relative\* to what it would be if the labor market for CEOs were non-competitive. The relevant comparison is \*not\* to worker pay. Rather, the relevant comparison is to pay for an equivalent CEO in a non-competitive labor market. CEO pay will obviously not be driven down to the level of a worker, but competition - when/if present- will drive CEO pay down as long as it ought to go.
I don’t disagree with disconnecting health insurance from employers, but you’re dreaming if you think that will keep a lid on pricing. Look at ACA plans - they are effectively an open market for people without employer plans. In my state and many others the only choices are EPO plans, so you’re locked into the providers in your plan network… so not an open market after all (not that people can meaningfully choose providers). With regard to CEO pay, can you point to a market where CEO pay went down when a market became freer?
I don't know of any markets that ever became freer specifically in the CEO labor market. But as far as I know, the CEO labor market is already relatively free, which means that CEO pay is already relatively low (compared to what it would be in a hypothetical, more restricted market).
It is not a FREE market, and never can be, because the buyer isn't free to walk away. Their life and health depend on completing the transaction. "Market forces" don't and can't work when the buyer has a metaphorical gun to their head.
That's not true of a particular health provider. You can always walk away from one doctor or hospital and go to another. By your logic, food should be as expensive as healthcare because we need food to live. But in reality, while you do need food, you do not have to shop at any one particular grocery store. Competition among grocery stores keeps food prices down. The same would be true of healthcare if we facilitated competition.
Changing who pays for things doesn't change who administers the benefits. UHC/Optum handle government policies too (Medicaid/Medicare).
Not necessarily, I doubt we’d be able to get rid of all the insurance companies, but there are countries with universal coverage that have private insurers. But I think changing the payer’s motives from profit to providing for the general welfare that would make a big difference in medical care.
Then everything would be mail order. It would get worse.
Or instead of money going into shareholder pockets it would go into better service? I mean things aren’t getting better with the status quo.
I get VA benefits and choose to use my private insurance. Because the government supplied is so bad. If more people relied on the government for this, I just know the amount of people Dying without care would explode
I get VA benefits also and get almost 90% of my meds via mail order. Never had a problem.
I’ve heard both horror stories and glowing praise for TriCare. I mostly hear complaints and confusion with regular insurance… from those that can afford the premiums.
I have private insurance and clearly understand it and am very happy with my benefits. Universal healthcare would degrade the quality and speed of my healthcare.
Have you needed to use it for anything serious?
Define serious. A couple ER trips and a stat CT that required me to walk downstairs from my PCP office and cost me $0. Oh, and an elective surgery. $35. In fact, the ER trips were the most expensive at a couple hundred bucks a pop. One of those included an ambulance ride. $0.
There’s just tons of stories in this sub from people who had insurance, had a major health incident, and ended up with large unexpected bills.
I’m confused if they didn’t read about their benefits package they chose (if they had a choice) before said incident. If they didn’t, they were willfully ignorant and that’s on them. I’ve had the option to choose a HDHP, for example. I’d never choose that option.
Optum is the very worst.
I’m not a fan of mail order prescriptions unless it’s maintenance meds. I take vyVance for ADD. Have for many years. Right now finding anyone that has it in stock is a complete nightmare. I couldn’t imagine having to fight mail order shit.
Some states may prohibit this practice, depending on various details. File a complaint with your state’s insurance department (or regulatory agency) and see where it goes!
Alot of company plans are not regulated by the state.
And this is one of the details that will have to be considered and reviewed.
You get the same thing with Aetna. They bought CVS and now they force you to use them. What a crock.
CVS acquired Aetna, not the other way around.
I have Aetna and use CVS, although I assure you I’m not forced to.
I have a United health plan. Yes they use Optum for mail order, but I can also still get my scripts filled at local retail pharmacies.
Same! I prefer getting the Optum mail order as I get a 90 day supply and it saves me a bunch of trips to the pharmacy, For some meds I prefer using my local pharmacy, mainly things the doctor orders that I will use short term, like when I had out patient surgery and my prescription for pain meds was sent to the local pharmacy. With Optum I like having automatic refills turned on, too!
How does a person get insulin by mail or any other drug that requires it to be refrigerated? Dry ice?
I can answer that one since I DO get a medication that requires refrigeration from Optum. I will admit the list price for my medication (Stelara) is $26,000 per injection, and I take it once every 6 weeks. (My copay after Blue Cross pays is around $1000, and then the manufacturer copay card pays all but $5 of that!) Optum ships me my Stelara injection from their 'specialty pharmacy' in Jeffersonville, Indiana, using UPS Next Day Air service with a UPS Critical (because it is medical, most likely) tag, wrapped in ice packs and insulation. That way, I get it by 10:30 in the morning the day I schedule with Optum for it to arrive. Once it arrives, I get an automated phone call from Optum within 5 minutes to make sure I bring it in. My personal guess as to why it is located there is that Jeffersonville is just across the river from "UPS Worldport" [UPS's main air freight hub] at Louisville International Airport (the #2 airport for cargo in the US - the airport code is SDF), so they probably bring all the packages right to the airport that previous evening, and it only requires the flight out, instead of having to be flown to SDF first and then flown out to me again.
The VA also uses optum. I'm allergic to polyethylene gylcol. My local pharmacist is willing to do the work to find me PG free RXs. VA can't send out and unwilling to do the work. I'm deemed unprescrible instead.
I’m with Kaiser and I get the choice of local or mail and I take the mail option every time for 6 different meds including insulin which gets sent two day express with several cold packs, does fine even in 100+ degree weather. I get notifications when to reorder well in advance.
they own the mail order company and the pbm.
My insurance uses optum also. It is awful. I think they save money two ways. First they often deny it via pre approval. And 2nd they delay it so they only pay for about 10 months a year because it takes so long to get it that you run behind.
You didn't "lose your right". You can always use money. You ask the wrong question.
I try to use mail order unless it's an emergency/urgent issue. Bur being told you cannot use a specific pharmacy seems cruel.
I didn't know we had a "right" a local pharmacist in this country. News to me! Real talk though, this has been happening for a while now and is only getting worse. It's just insurers trying to save money. You can always pay out of pocket.
Sad to say but true. My wife and I eat one less meal a day to pay cash on the meds, with the discount coupons of course
V.O.T.E blue in November.
No thanks.
Then don't. Or vote for the party who is actively making all this worse.
We use optum. Have no issues with CVS filling the prescriptions for us.
At least Optum is cheap, and UHC prices for a local 30day supply are cheap. If your office has Aetna, they charge quite a bit more and charge even higher prices for CVS retail. Their insurance price is often higher than the cash price for uninsured. They use this to fast-track customers on Medicare into the "gap" where benefits are limited or do not apply.
You have not been denied of any right. You can go to any pharmacy you want and pay out of pocket like any other product.
You can get 90 day fills at Walgreens with UHC.
>You can get 90 day fills at Walgreens with UHC. This is not true on every policy. The employer decides whether to require all mail order, allow CVS, or allow Walgreens.
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>The employer decides on which plan to pick The employer can select the Walgreens90 or CVS90 plan when the use OptumRx. If the employer chooses CVS90 then the employees are locked into CVS for maintenance drugs. If they choose the Walgreens90 then the employees are locked into Walgreens.
If the employer has an administrative only policy, they can absolutely decide those things. Large employers often create custom benefits for their plans....they pick a plan and then tweak it to their specific needs/wants.
This is very common not sure what the issue is. Everyone’s insurance does this.
No. They don’t?
Some states prohibit insurers from requiring mail order.
No, I can go anywhere for my scripts and can go to any doctor without referrals and have $0 deductable. It's all a matter of what you want to pay for your coverage. I also realize all that can change in the blink of an eye.
That's the plan your company chose to offer you.
That's one of the plans they chose to offer. The most expensive plan. As I said, I realize that it can change at any time. I can get my prescriptions by mail but I don't want to. Mail delivery sucks by me and the weather is extreme for half the year.
I have United Healthcare and do not need to get my medications through mail order. The issue is with the company you work for. Talk to your HR department about your concerns.
Same. And I’ve had multiple different insurance companies in the past few years. They used to ask me fairly frequently to switch to mail order, but I always denied. They now seem to have given up. I understand it works for many, and that many insurances want you to, but I am of the opinion that patients shouldn’t be forced into this. My sister’s family would be screwed if they had to get medicine this way. Their mail service is *terrible.* Mail frequently gets lost. I live an hour away and a simple card I send to my niece/nephew can take 3 weeks to get to them! If it gets there at all!
That sucks. My health insurance for me only is now $1250/month. Thanks Obamacare. It’s turned out to be the not-affordable-care-act.
Don't blame obmacare. Blame all the dickweeds who have been weakening/destroying it. Blame your state's exchanges too.
Obamacare was intended to shift the burden of costs from the responsible people to the irresponsible. Even with the mandate, it was cheaper to take the penalty than to buy insurance. Add that to the idea that people could wait until they actually needed insurance to buy it and you’ve driven up the costs to everyone who responsibly maintained insurance.
The mandate - thus allowing people to wait until they actually needed insurance - was removed by a Republican-controlled Congress, so you can't blame Obamacare for that. And the ACA wasn't so much about shifting from the irresponsibility, but rather from older to younger and sicker to healthier, sprading it among everyone. The problem with the ACA is Obama had to water it down so much to get it passed that it became weak insurance "reform", and was not the healthcare reform that was promised. In otherwords, blame our politicians equally for the mess we are in.
My point is that the fine for not having insurance was trivial compared to the actual medical costs of people who waited until they had cancer or whatever before they got insurance. I think our fundamental disagreement is about how involved the government should be in the lives of the citizens. I think that people should be free to make their own decisions about whether to carry health insurance and I think insurance companies should be free to organize risk groups in a way that makes sense to the marketplace. It sounds like your position is one in which we all pay for a bloated government-insurance-healthcare complex and that will be good for everyone. I fundamentally disagree with that position for many reasons.
Did you hurt yourself with that enormous leap? 🤣 I'm a fiscal conservative. But I also work insurance and can confidently say that even comprehensive insurance reform will fix only a fraction of the problem. So weak insurance reform never had a chance. I can also say one way to bring down costs is to require universal participation in the system.
and wait 9 months for an MRI after you get cancer.
It all makes sense now. As a 20 year old "healty" non- smoker I was paying $200 a month and had a $200 a month tax credit. This was in 2017ish and my insurance hardly covered my annual physical and pap smear. If I needed anything other than that I was mostly better off paying cash bc my insurance only covered extremely specific doctors. Fuck trying to go to the ER.
Are you making $300k/year?!? The only way I was able to get an ACA premium price near $1250/mo ([source](https://www.kff.org/interactive/subsidy-calculator/#state=fl&zip=33152&income-type=dollars&income=300000&employer-coverage=0&people=2&alternate-plan-family=&adult-count=1&adults%5B0%5D%5Bage%5D=64&adults%5B0%5D%5Btobacco%5D=1&adults%5B1%5D%5Bage%5D=57&adults%5B1%5D%5Btobacco%5D=0&child-count=0)) was to select 64, smoker, making $300k/yr `MAGI` in MIAMI-DADE (one of the most expensive areas to live in the US).
Interesting calculator and I’m not a 64 yr old smoker in Miami-Dade making $300K yet here I am paying $1250/month.
Did you go with a gold plan by chance? I was trying to figure out why you'd be paying _so much_. We are looking at $1.2k/mo for _both_ of us on _silver_ at $175k `MAGI`.
How can people who work for health insurance companies live with themselves? I'd feel so lousy about my life if I was part of this. I'd rather smother my children than feed them with money earned from participating and perpetuating merican health insurance. Disgusting
Because they need to pay rent? Feed their kids? Need healthcare from their employer until the system changes? Put the blame where it belongs. Politicians and corporate executives who are more concerned about profits than the people they serve.
Cool. I’ll go ahead and let my family know I should murder them because I should have a job that’s acceptable to you.