Complaint Review: Express Scripts

 I have the Express Scripts prescription insurance plan through my wife's work, as I am considered a "temp" at my job (been working same position full time for 2 1/2 years) and therefore am not eligible for insurance benefits through my own workplace.

I also suffer from chronic kidney disease and have recently (October of 2013) receive a transplant.

At the end of the month after receiving my transplant, I received a letter from Express Scripts informing me of an "important benefit" that could "save me money" - the letter stated that I must order two specific medications from Medco Pharmacy, which is owned byExpress Scripts, or else I would be responsible for the ENTIRE COST of the prescriptions, which I had been receiving fine through CVS Caremark. The letter stated that Express Scripts would pay for the first two fills of these medications, but afterward would not cover them at all UNLESS I bought them from their own company.

The specific medications named in the letter were mycophenolate and tacrolimus - anti-rejection medications commonly given to organ transplant recipients. Without taking these two medications as required, a transplanted organ will fail.

This where we get to the really great part (after all, if copays were similar, I don't much care where I am filling the prescriptions as long as they are in fact being delivered).

My state of Pennsylvania runs a Chronic Renal Disease Program. The CRDP is an income eligible program that limits the cost of generic prescription drugs to $6 and name-brand drugs to $9 for kidney disease patients on dialysis or post-transplant.

This means my total cost through CVS Caremark for mycophenolate and tacrolimus was $12.

However, Medco will not work with the state CRDP (pharmacy participation is voluntary). Instead, they are now charging me $70 per month for two medications that I need to take.

I fail to see how this is any different from extortion - not only can Express Scripts essentially tell me what it is I have to pay for medicine, they can also tell me I am only allowed to buy it from their sister company pharmacy? A medication that is nominally on their formulary? And do it only after the fact? No prior notification? AND force me to pay $58 more every month for the same pills?

A joke of an appeals process was referenced in the letter I received - I had about two weeks to go before my second fill and the only appeal I could file was through snail mail. No calling, no number, no customer service - regular mail. I took the letter to my social worker who contacted Medco and Express Scripts and fought for a week or two to try to get some kind of information from them, to no avail. Her advice to me was essentially deal with this as long as possible, then drop them like a rock, because there is no choice here.

I also find it noteworthy that we are not talking about simple, cheap medications here - the two medications specifically named are most important for any transplant recipient as they prevent rejection of the organ. It's kind of as if Medco and Express Scripts intentionally sat down together to decide what they could do to strongarm Express Scripts customers who are organ transplant recipients into becoming also Medco customers against their will. Their letter said to me, in so many words, "We will force you to become a Medco customer, or we will force you into transplant rejection". All described as if this was a great benefit that was saving me money when I am actually out hundreds, if not thousands, of dollars in the long term.

I am reasonably certain it ought to be against the law for the same company to operate both an insurance plan and a medical provider, or if they do operate both together, they should have minimum standards of coverage that they must meet (I think allowing customers to buy prescriptions through somebody else is sort of a bare-bones minimum standard of decency here).

Sadly, that is not the case, and in Pennsylvania anyway, Express Scripts and Medco Pharmacy together will take advantage of that to rip off their customers as soon as they get the chance.

I would advise all future readers of this complaint to avoid both of these companies at all costs.