Thursday, January 5, 2012

Express Scripts/ Empire Blue Cross (Wellpoint)

The following sequence of letters, emails and notes constitutes the entire correspondence and notes relating to the timely and accurate filling of prescriptions by Express Scripts and the incompetence with which they are fulfilling their obligations under a contract with Empire Blue Cross (a subsidiary of Wellpoint, Inc)
The only modifications to these notes are the removal of some personal identification information and the names of the drugs involved in order to maintain the privacy of the individuals involved.

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Dec. 29, 2010

Ms. Angela F. Braly
Chair, President and Chief Executive Officer
WellPoint, Inc.
120 Monument Circle
Indianapolis, IN 46204

Dear Ms. Braly,
I am a customer of Empire Blue Cross. I am disappointed enough right now to write this letter to you about the overall quality of services provided by Express Scripts. I am not looking to have you correct a situation on my individual script, I can certainly go to the trouble of fixing that, but rather I am writing to bring to your awareness the low quality of service that Express Scripts is providing to your customers.

I have not kept track of all the numerous screw ups by Express Scripts since my plan was switched to them, but to put it bluntly, I have had so many prescription orders vaporize or get delayed in delivery so many times that I must consider whether I want to subject myself to this type of abuse any longer.
I just got off the phone in yet another attempt to straighten out a prescription problem with Express Scripts personnel. This one was a new twist and has prompted me to write this letter.
I have a script that states on the label (in part):
Refills:2 (Reorder After: 12/10/2010)
The automated system would not refill the script and did not explain what was going on, nor did it give me an opportunity to speak to a human. I called back and spoke to a human who explained that the script had expired in October and that I would have to have my doctor write a new script.
Pardon my being put off by this, but if Express Scripts puts a notice on the bottom of the previous script as I indicated above they could also have put a notice on that same script that the script was about to expire and that I should have a new script sent in my my doctor.
If that had been done, then I would have followed up on that and sent in that new script back in October and not had to go to heroics during this holiday season to round up my doctor, who is most likely on vacation, and try to get a supply of the drug before I run out of it.
I must say that as an IT professional I would not tolerate such consistent incompetence on the part of the staff running an operation like this.
Sincerely,
XXXXX
cc: Mr. George Paz
Chairman of the Board
President and Chief Executive Officer
Express Scripts
One Express Way
St. Louis, MO 63121

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April 29, 2011

Ms. Angela Braly
President & CEO
WellPoint Inc.
120 Monument Circle
Indianapolis, IN 46204

Re:Express Scripts
Dear Ms. Braly:

I am an officer of XYZ Corp.(this being a fictitious name for purposes of this blog) and the individual responsible for the selection and administration of the heath benefits at our company. We currently have a contract with Empire Blue Cross to provide these services. While I am, in general, satisfied with most of the services Empire has provided, I must confess that we have become rather alarmed with the services that are being provided by one of their contract providers, namely, Express Scripts.

We understand Empire’s need to select a prescription provider that will provide services to its members at very competitive prices. But, it must also take into consideration the quality of the services provided by these providers. For example, I am sure that for the sake of saving a few dollars they would not want to jeopardize the health and safety of your members. I have only recently come to the conclusion that Empire is, perhaps unwittingly, by choosing Express Scripts, doing just that -- namely, potentially sacrificing the health and safety of its members in order to save a few dollars. The only other alternative that I can think of is that Empire is participating in this situation with full knowledge, and that might actually be both immoral and criminal.

I will outline below the rationale for the conclusions to which I have come. While it is difficult for me to fully understand all the aspects of this situation, I think you will get a clear picture. I’m sure that what Empire originally thought was a good idea, has clearly gone very awry. My records of the incidents described herein are not intended for presentation as evidence at a legal proceeding with dates, and names, etc. but, still, annecdotally clear and convincing.

It was right after Wellpoint sold Next Rx to Express Scripts that we found it odd that medicines requiring preapproval that had been previously approved by Next Rx now required re-preapproval. We complied with the Express Scripts requests and had members reapply for approval.

It was shortly thereafter that we found that prescriptions that were either on file or represcribed or were being prescribed for the first time were not being filled. Upon investigation we had members request that their doctors resubmit these prescriptions. In many cases they were being filled. We concluded that perhaps the doctors were not being diligent in their ordering of the prescriptions, or that the prescription reporting process was not clear. The number of incidents appeared to be escalating through time.

We started hearing from doctors about the frustration they were having, particularly with Express Scripts. Their prescriptions were being lost by Express Scripts. We started hearing from other sources that other members, not with our company, whose prescriptions were being filled by Express Scripts were either having their prescriptions lost, or not being filled on a timely basis. Alarmingly, we heard of members who were going to their local pharmacy to have their prescriptions filled and paying the extra premium for this option rather than deal with the Express Scripts amnesia. This couldn’t have been done intentionally in order to increase the copay from the individual members, could it?

We have members who are receiving robo-calls from Express Scripts with regard to reordering of prescriptions and not indicating which family member it was for, only to find out when returning the call that the correct family member must be present in order to provide the security information required, and then to find out that the message was in error. We have had members who have reported this happening multiple times for the same prescription (we have one case of four times), or members reporting that there was no prescription that was in need of being ordered. We have a report where the robo-call occurred two weeks after filling a prescription.

Recently, we have a report of one family having had to reorder nine times in order to get their prescriptions filled by Express Scripts due to the prescription being “lost” by the sytsem..

We have taken the opportunity to do a little research and found and read reports that a significant number of employees of Express Scripts appear to be very disgruntled and vocal about the adverse conditions within the processing facilities operated by Express Scripts. I have heard of disgruntled Postal employees and the terrible consequences of those employees taking out their frustrations on innocent bystanders. I would hate to have a prescription filled by a really disgruntled employee. How would you feel about that?
We have read about management problems at these Express Scripts facilities. We have also heard about turnover and training problems at Express Scripts. We have even read about questionable labor practices.

We have also learned that there seems to be a real problem with the input software at Express Scripts - that there are too many errors or glitches encountered and that the backlog in the input area has become so excessive that it has caused orders to be either lost, misfiled, or even worse, improperly recorded. In one instance, we read of outsourcing the input process to India or some other third world country. Perhaps this explains the reason why we are seeing prescriptions that are being lost by Express Scripts.

We live in a time when medical costs are expensive and the costs are rising. I can only imagine the financial burden and frustration that this ineptitude and incompetence has placed upon the medical community that has to deal with it on a daily basis.

We have also read of the Aetna legal action against Express Scripts, and the alleged reasons for the suit, which I am sure you are quite well aware of these allegations and I need not repeat them here.

So, as you can see, this does not paint a very pretty picture of the performance of Express Scripts, and consequently, the performance of Empire. I am sure that this is not the first letter on Express Scripts to address this matter. While I am not prepared to take action quite yet, I would like to give you an opportunity to respond to the observations illuminated herein.

I read an article about you in Diversity Journal where you are quoted as saying: “My Philosophy: Do the right thing. Do it for the customer. Do it right the first time.”

Sincerely,


Officer XYZ Corp.

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May 8, 2011
Good day Mr. XXX (XXX is a pseudonym used for the purposes of this Blog),
I hope you are well and arrived safely. I am following up with you from our conversation on Friday, April 29, 2011. I was advised the Express Scripts Service Delivery Manager, Vatayshi Borroum contacted you in regards to your letter to Angela Braly. If he has addressed your concerns please advise and I will advise our Executive Team. Otherwise, I will pursue the matter further.
It is definitely my intention on behalf of WellPoint to resolve matters in a timely matter. Please let me know how I can provide additional assistance regarding your inquiry.
Be safe in your travels and I look forward to hearing from you soon.
Thank you,
Renata Brown, CPhT.
Pharmacy Services Coordinator
WellPoint Pharmacy Solutions Group
Renata.Brown@Wellpoint.com | 17177 Preston Rd. STE 325 | Dallas, TX 75248
( Office: 314.923.8494 | ( BlackBerry: 972.955.1320
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
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May 8, 2011
Ms. Renata Brown:
Good afternoon to you too. If you are a mother I hope that you at least had an opportunity to celebrate Mother's Day today.
Yes, all the prescriptions arrived. There were many phone calls on the matter from Express Scripts. I even thought, at one point, that they were going to send multiple duplicates to me since I had already received one prescription and they called asking for clarification on the delivery address for another shipment of the same medicine.
However, my fundamental questions still remain. I am uneasy as to whether the prescriptions I do have are being filled by disgruntled employees who want the company to suffer unnecessary liability on a misfilled prescription, intentional or not.
Also, the basic question as to why our prescriptions seem to be almost always bungled in one way or another.
I would not have written that letter if merely filling those specific prescriptions was the end of the discussion.
I would still like to hear something from Ms. Braly on point to the issues I raised.

Sincerely,
XXX

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6/29/11
Good afternoon Ms Brown:
I hope that you don't think that I have forgotten about my email of May 8. I had not been following up because, as I had indicated to you previously, I was in Europe for the last few months and did not have my normal routine.
Now that I am just back, I do want to pursue the matter further.
It appears that nothing has changed during my absence. If you will read my original letter to Ms. Braly, you will note my discussion about the robo-calls.
Today, I received a robo-call indicating that there was some important information for me if I would merely provide my date of birth. Try as I may, I was unable to get the miscreant to understand my date of birth either verbally or by keying in the information.
I ended up calling your toll free number and speaking to one of your representatives. She informed me that they have been having trouble with the software that recognizes dates and apologized profusely. When I asked her why the automaton called me she informed me that it was going to tell me that one of my prescriptions was in need of being refilled.
I told her that:
1. The prescription in question was not in need of being refilled, and
2. That I had already specifically requested on numerous occasions that I not be called by the robo-caller about such matters, as they were almost alway wrong. I had been specifically told on a number of previous occasions that I would not be called again in such a manner.
I explained to her how disheartening it was to deal with a company that makes so many errors in dealing with its customers. I hope that the number of errors being made by these employees is not the same number of errors being made by those who are actually filling the prescriptions. It would be disastrous.
A full response to my concerns would be appreciated.
Sincerely,
XXX
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6/29/11
Mr. XXX,
I will be out of the office for the remainder of today, Wednesday June 29. If you need immediate assistance please contact dl-Plano PSG Coordinators, otherwise i will return emails on Thursday.
Have a superday!
Renata Brown

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6/30/11
Good afternoon Mr. XXX,
I have been in touch with Express Scripts regarding the robo-automated calls. They acknowledged that your requests were made to stop the calls and they apologize for the inconvenience. It seems as though, when they receive a request an email is forwarded and the request is then completed by someone manually removing the telephone number from the profile. That is where the error occurred.
I was placed on their email to correctly remove your telephone number and will be advised upon completion.
I will also check on the response to your letter from April 29.
Thank you,
Renata Brown, CPhT.
Pharmacy Services Coordinator
WellPoint Pharmacy Solutions Group
Renata.Brown@Wellpoint.com | 17177 Preston Rd. STE 325 | Dallas, TX 75248
( Office: 314.923.8494 | ( BlackBerry: 972.955.1320
PSG is closed for Independence Day July 4th, and will be on PTO on July 5th.
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6/30/11
Ms. Brown,
Thank you for your very prompt response. I was actually not expecting you to get involved in following up on such an inconsequential matter. I was merely using it as an example to illustrate that, from my point of view, nothing has changed since I first wrote to Ms Braly. True, my original letter, in part, was about this very issue, but many other much more consequential issues brought me to the point of being be very concerned about the company that I was dealing with and the potential for serious error or even sabotage. Considerable time has passed and, apparently, no action has been taken to remedy the situation, as far as I am seeing the situation -- not even any meaningful response to the issues I raised in my original letter.
I will await a reply that responds the true gravity of the situation, not just following up on an inconsequential mistake.
Regards,
XXX
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7/7/11
Good morning Mr. XXX,
I hope you are well. I apologize for not responding sooner, as I was out of the office for a few days for the Independence Day holiday.
As I previously advised, I was on an email with Express Scripts to remove your phone number from the automated calls. It has been confirmed that the phone number on file with Home Delivery has been added to the Do Not Call List, and you should no longer receive any additional calls. Also, I was advised that research has been completed and you should receive a response to your letter to Ms. Braly.
I apologize for the problems you have experienced and if I can assist in the future do not hesitate to contact me.
Thank you,
Renata Brown, CPhT.
Pharmacy Services Coordinator
WellPoint Pharmacy Solutions Group
Renata.Brown@Wellpoint.com | 17177 Preston Rd. STE 325 | Dallas, TX 75248
( Office: 314.923.8494 | ( BlackBerry: 972.955.1320
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7/5/11
Dear Mr. XXX:
Thank you for your letter of April 29, 2011 to Ms Angela Braly, Chair, President and CEO of Wellpoint, Inc. regarding the selection of Express Scripts as the Pharmacy Manager for Empire Blue Cross and your experiences with Express Scripts.
In May the Express Scripts Service Delivery Manager, Vatayshi Borroum, spoke with you about your mail order concerns regarding prescriptions about your family and at that time your concerns were addressed.
Upon researching your inquiry with Mr. Borroum, we determined that Express Scripts received a new prescription for Mrs. XXX in July 2010. The claim rejected because a prior authorization was needed due to there being no previous trial of the medication in the previous 180 days. The previous prescription was filled in November, 2009. All prescriptions were transferred from Next Rx to the Express Scripts system and are showing on your family's profile. Orders are scanned and input when they are received and there are numerous safety checkpoints in place to make sure all prescriptions are input and processed correctly.
Renata Brown has informed me that she has worked with Express Scripts to completely discontinue the automated calls you continued to receive.
We maintain working relationships with a number of U.S. based companies that provide global services. All work which is completed outside of Wellpoint is subject to the same quality standard, security and control as our in-house locations. Wellpoint cannot comment on the employees of Express Scripts or any possible legal action taken. However, we strive to continue our efforts to provide and maintain the best in customer service.
Thank you for bringing this matter to our attention and we apologize for the inconvenience you have experienced. Should you have any questions regarding this matter, please contact Renata Brown at Wellpoint Pharmacy Solutions at 314-923-8494.
Sincerely,
Michael Lindsey
Wellpoint, Inc.
3820 American Drive
Plano TX 75075
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1/5/12
Dear Ms Brown:
I wish I could say that the problems have diminished, but. alas, they are resurfacing again, or more accurately, they only ebbed for a short while. Unfortunately, the letter of reassurance, or whatever it was that Ms. Braly expressed, has not been followed through with actionable changes by your organization.
My wife had one of her physicians FAX in to Express Scripts on 12/21/11 with an Rx. We have a copy of the original Rx, signed by the doctor and stamped FAXed and date stamped 12/21/11. We asked that that documentation be sent to us at the time the Rx was ordered by the physician because of the past problems. Yet, Express Scripts again disavows any knowledge of receipt of the Rx. If this were an infrequent occurrence I would chalk it up to "that's life", but in the case of Express Scripts we cannot assume that any longer. It happens way too frequently to be random error, and we note it especially with all the expensive meds. And, if you assume it is the physicians office, we have experienced the same problems with multiple physicians. And the physicians all say it is particularly worst with Express Scripts.
Any organization that makes this many errors can not to be trusted with the medications that they fill. Or, could it be that they are not errors at all, but rather a carefully orchestrated attempt to slow down the filling of expensive meds to encourage those patients to leave the health plan.
We have asked the physician to call it in again and document the transaction and send us a copy of the transaction. They now claim that they have sent in the Rx three times.
My wife will be out of meds in a few more days. We, of course, could go to the pharmacy and pay the additional $70. for the transaction, but that is just not fair to burden us with that expense. We pay substantial sums for the insurance even though the benefits are very limited since we are on Medicare and Empire Blue Cross is our secondary insurer.
Sincerely,
XXX
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1/5/12
Good afternoon Mr. XXX,
I sincerely apologize for the problems your wife and physician have experienced in getting her prescriptions filled. That is not what I wanted to hear when I saw your email come through.
Please provide me with your wife’s name, date of birth and her ID number so I may locate her in the system. Also, just in case I need to reach out to her doctor, may I have the physicians name and telephone number. Also, what medication is needed?
I will update you tomorrow after I have additional information.
Thank you,
Renata Brown, CPhT.
EBS Coordinator; Enterprise Business Services, WellPoint Inc.
Renata.Brown@Wellpoint.com | 17177 Preston Rd. STE 325 | Dallas, TX 75248
( Office: 314.923.8494 | ( Mobile: 972.955.1320
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1/5/12
I am including here the information you requested.
(personal information deleted)
Subsequent to my last email to you I reached out AGAIN to Express Scripts. There is still no record of a Rx according to an Express Scripts representative with whom I spoke. She offered to call the physician and send them a form to send back. I indicated that the doctor would be in today, but not tomorrow. They indicated that it would be difficult to get back today. So, it goes. My wife is now using sleep as the only alternative to the meds. Thank goodness the rep did not go through the usual routine of requiring my wife to get on the phone to verify that she has given me permission to speak for her (or was that some violation of the confidentiality rules?).
Regards,
XXX
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1/5/12
Mr. XXX,
I contacted Dr. ZZZ (a pseudonym for purposes of this Blog) but she was seeing patients and I was unable to speak directly to her. However, I spoke to Yolanda and we realized that the fax number she was using was incorrect. I provided the correct fax number and she advised that she will fax the prescription shortly. I have sent an email to Express Scripts to monitor your wife’s profile for the prescription and I will also monitor the progress tomorrow.
I will send you an update once received.
Thank you,
Renata Brown, CPhT.
EBS Coordinator; Enterprise Business Services, WellPoint Inc.
Renata.Brown@Wellpoint.com | 17177 Preston Rd. STE 325 | Dallas, TX 75248
( Office: 314.923.8494 | ( Mobile: 972.955.1320
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1/5/12
Thank you, but do realize that the number she is using is the number just recently given to us by Express Scripts.
Regards,
XXX
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1/5/12
Ms. Brown,
I see on my MasterCard transaction record two pending transactions from Express Scripts.
I called ES and asked and they informed me of the Rx for myself and one for my wife that are in process of being filled.
Thank you for you assistance in getting my wife's Rx going.
On the matter of the FAX numbers at ES. Clearly, people in your organization are giving out a FAX number that is fully functional and capable of receiving incoming FAXes, but is clearly not the one that people should be using. This has happened so many times now that you must bring this dead end loop hole rabbit hole to a halt. I know that I have fallen prey to this one a number of times in the past. I do not keep the FAX number in my contact list, but rather get it each time I need it. ES is delivering the wrong number, or alternatively, whatever number they are giving out could easily become a valid number to send Rx's to if it is under the control of ES.
Please reign in this incompetence in your organization.
Thank you once again.
XXX
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1/5/12
Ms. Brown,
One final note on this go around. I am sure we will be speaking again.
I know that I have mentioned this before. You must have some inkling of the amount of time that is being expended by us, your other customers like us, doctors, their support staff, Express Script, and even your organization.
I am sure that I am not the first to point you to the problems that are discussed ad nauseam openly on the internet, as for example at these sites to mention just a few:
Some of these horror stories have happened to us already.
This cannot continue with the status quo.
I hereby put ES on notice that we do not want auto refill on Rx's, nor do we not want auto notification of Rx's that are in need of refill.
Neither of these were ever elected by us. I know that last round in 2011 it took considerable effort to get these unapproved services stopped. Please do not have ES reinstate these features unless you receive written notification from us to the contrary, signed and notarized.
Interestingly, I heard on the financial news yesterday that Express Scripts is the most shorted stock in the S&P500 with about 50% higher short interest rate than any of the other 500 large publicly traded companies on any of the stock markets. This means that the investors think that ES is the worst positioned large company there is, without any competitors. Combine this with the fact that most health care companies have thrived during 2011 begs the question of when the entire company will go down the rabbit hole.
I cannot believe that quality control can be maintained under such circumstances. There are too many opportunities to take short cuts that could jeopardize the health and safety of the people whose prescriptions are entrusted to your care. There comes a point where dropping the ball becomes negligence after so many repeated problems.
Regards,
XXX
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1/6/12
Mr. XXX,
Express Scripts is currently processing the prescription and once completed, it will be updated to next day shipping per my request. Your prescription is also in processing and processing can take up to 3 to 5 days. Once processing has completed, I have also requested expedited shipping for your prescription.
There does appear to be a bit of confusion with the fax numbers and I am working with Express Scripts on how to resolve the issue.
I apologize for the inconvenience, and I will keep you updated on your prescriptions. If I can be of additional assistance please let me know.
Thank you,
Renata Brown, CPhT.
EBS Coordinator; Enterprise Business Services, WellPoint Inc.
Renata.Brown@Wellpoint.com | 17177 Preston Rd. STE 325 | Dallas, TX 75248
( Office: 314.923.8494 | ( Mobile: 972.955.1320
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1/9/12
Good evening Mr. XXX,
I checked the status of your wife’s prescription and it shipped out with UPS on 1/7/2012 and it should be delivered today. I am also showing your prescription with a date of 1/7/2012, but it has yet to be updated with UPS. For your reference, I have included the tracking number.
Thank you,
Renata Brown
EBS Coordinator
WellPoint Inc.
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1/11/12
Ms. Brown,
My wife did, in fact, receive her Rx on 1/9. Thank you so much for the assistance in getting it filled through Express Scripts. We always prefer to have it go through smoothly, rather than have all these heroics utilized.
A few notes.
First, while your email below indicates that my Rx was shipped on 1/7, I have learned that, in fact, it shipped on 1/9 and only arrived here a short while ago on 1/11/12 (actually, I do not know exactly when it arrived today. It was sitting in the sun near the front gate when I happened to be passing by. There is no indication on the package that its contents are refrigerated and should not be left in the sun.). The contents were still cold, so I am relieved that it has arrived safely. I was starting to get concerned about it being in transit for 4 days. However, I spoke to a pharmacist at Express Scripts, who assured me that it really wasn't sent on the 7th, although it was packaged for shipment and sat in a refrigerator at the ES facility for two days.
Next, there was some confusion introduced by the fact that despite these being Rx's of the new year, with a new deductible applicable, no deductible was charged. In the case of my wife, she did fill another Rx locally since then and the deductible was charged. In my case, I have not been charged the deductible yet. I am sure I will be on my next order.
Thank you, again, for your assistance, and hoping that ES can straighten out its problems.
Regards,
XXX
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1/20/12
Dear Ms Brown,
Following up our discussions of earlier this month, the saga continues. The number of convolutions to this tale is unbelievable.
My wife, today, received a letter from Express Scripts. I include it here for your perusal. The annotations in the upper right are mine.
(Image of Letter from Express Scripts removed due to the personal nature of the information contained. However, in the letter it states that the Rx [for the medication we have just recently received] was not going to be filled because it has already been filled. This Rx will be filled on 3/6/12)
You will recall that she received her prescription on 1/7/12. It was Rx number ggggggggggg.
It was for her usual prescription. I include here a partial of the label from the bottle itself:
(image of the Rx label for Rx number gggggggggggg has been omitted on this Blog due to the personal nature of the information.)
The reason I am going to such lengths to document this will become evident as we proceed.
I called the Express Scripts telephone number as suggested to attempt to straighten out the situation.
I was told that the reason I received the letter was that they had received a second Rx for the prescriptin, and since they had just filled the one Rx, they could not fill another until 3/6/12 as indicated in the letter. I was, in fact, told that two additional Rx's for the prescription were received.
The only conclusion I can come to is that the original Rxs that were claimed not to have been received by Express Scripts have magically appeared after all, which brings us to the point that there is some kind of serious problem at Express Scripts in terms of them fulfilling Rxs on a timely basis, especially for ones that are expensive.
The next point I want make is that this letter was allegedly mailed on 1/11/12. That implies that it was in transit with the US Postal Service for nine days. I seriously doubt this. The letter was mailed some time subsequent to the date that is on the letter. Which begs the question as to exactly how long Express Scripts was really sitting on the original Rxs. (Just think of how many hours of people's time have been wasted as a result of this incompetence.)
Next, while discussing the situation of the Rxs with the Express Scripts representative I realized that the reorder date on the Rx that was filled is indicated as 8/31/12 (see the image above, but for this Blog that image has been removed). Now, it doesn't take a rocket scientist to realize the problem with this. If the original Rx arrived on 1/7/12, the dosage would be expired by approximately 4/7/12, leaving the situation set up for another desperate round of heroics on your part some time in late March.
The representative I spoke with said that she was unable to make the change to the obvious error, but would, in fact, submit a request to a pharmacist to make that change. I must now call back next Wednesday to verify that the change was really made. (Even more of my time!)
As it was explained to me, the two unfilled Rxs will be stacked behind the current one so that we will not have to have a new Rx sent in April for the next round in June. This I will believe when it actually gets closer to the appropriate date.
I reiterate the points that I have been making since the first letter I sent to Angela Braly on April 29, 2011. There are serious problems with the fulfillment of Rxs at Express Scripts. They are clearly incapable of filling Rxs in a timely manner. Now they have made an error on the labeling of the Rx which, if it had gone undetected, would have caused yet more time and more delays. I am very concerned about what other errors, either unintentional or intentional might occur and the quality of the product that we are receiving from Express Scripts.
This matter must be escalated to a higher level of concern at Wellpoint. Obviously, my letter to Ms Braly did not result in any meaningful changes. Someone is going to get hurt through Express Scripts' negligence if this situation continues unchanged.
Sincerely,
XXX
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1/20/12
Mr. XXX,
I will be out of the office Thursday, Dec. 29. For immediate assistance please contact dl-Plano PSG Coordinators. Thank you,
Renata Brown
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1/20/12
Ms Braly:
As indicated below from the automated email I just received from Ms Brown, my contact with Ms Brown seems to have hit a brick wall, so to speak.
She seems to have been out of the office since 12/28/11.
I will forward the correspondence intended for her to you so that you may deal with it.
Sincerely,
XXX
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1/20/12
Ms. Braly:
As indicated in my earlier email, I know of no other contact other than you to communicate my situation to.
Sincerely,
XXX
(entire contents of previous email to Renata Brown is included here)
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1/23/12
Good morning Mr. XXX – thank you for your email of January 20, 2012, sent to Angela Braly, Chair, President and CEO of WellPoint, Inc., regarding the prescription for your wife. Our office will be happy to assist you with this matter. At this time, we have forwarded your email to the appropriate plan’s executive office for review and resolution. We will stay involved to ensure that this matter is handled in a timely manner. Please feel free to contact our office either by email execconcierge@WellPoint.com or at 1-800-572-6864 if you have any further questions or concerns.
Sincerely,
Dena H. Martin
Senior Grievances & Appeals Analyst
Executive Services
This message, including files attached to it, may contain confidential information that is intended only for the use of the ADDRESSEE(S) named above. If you are not an intended recipient, you are hereby notified that any dissemination or copying of the information contained in this message, or the taking of any action in reliance upon the information is strictly prohibited. If you have received this message in error, please notify the sender immediately and delete the message from your system. Thank you.
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
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1/24/12
Note to Self
I spoke to the Customer Care Advocate at ES and the error on the Rx that was noted on 1/20/12, contrary to what we have been told, has not been corrected. Further, the procedure for correcting it required us to have a direct conversation with a pharmacist. I spoke to the pharmacist and they are REFUSING to change that information at this time based upon their perception of the current usage of the drug. They claim that from their records her usage of the drug is minimal and does not warrant the filling of the Rx until 8/31/12 which is a total fabrication of the actual records and the usage by my wife.
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1/24/12
Ms Martin:
Does the email from you mean that Ms Brown is no longer involved in the interactions?
As indicated in my earlier email to her and Ms Braly the "Refill After" date on Rx gggggggggg was incorrectly indicated as 8/31/12, and thereby setting up the inevitability that at the time the Rx will be in need of being refilled that we will have to deal with that error. She will be out of medication on or about 4/7/12. Given the history of the ability of ES to fill this Rx on a timely basis, that would, no doubt, result in a lapse of medication.
As I was instructed on 1/20 by one of your Patient Care Advocates, I called today to verify that the date had been changed. True to form, it had not. Furthermore, I was told that the procedure that I was told to follow was not the procedure that would work. I was additionally informed that I must speak directly to the pharmacist to have that error corrected.
I was connected to the pharmacist and was informed that they would not change the "reorder after" date. I was further informed that the reason was that the computer showed that given the history of the usage of the medication, that reordering before that 8/3112 was inappropriate. This is all poppycock. It just further demonstrates ES's inability to deal in a competent manner with the information. This is dangerous and is going to get someone hurt.
Please see that the information is corrected and that I am informed when it is corrected.
Sincerely,
XXX
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1/24/12
Mr. XXX: Good afternoon and thank you for your reply. Mrs. Martin’s reply services as to acknowledge that your earlier email addressed to our CEO has been received. Ms. Brown is actively researching your issues and will respond to you directly.
Thank you,
Michael Lomerson
Senior Grievances & Appeals Analyst
Executive Services Unit
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise be protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
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1/24/12
Note to self
After a lengthy conversation with Ms Brown we have determined that the information that ES has espoused as to the sequence of events is nonsense. They claim that the date of 8/31/12 for the refill date is because subsequent Rx's will be filled prior to that date. Yet, at the time the Rx was filled and the Refill Date was assigned they claim that they had not received the other Rxs for the same drug. A contradiction. Ms Brown acknowledges that she has personally seen thousands of problems similar to this as a result of the actions of ES. She has confirmed that the only explanation is incompetence, or totally inadequate systems in place to deal with the situation. She is going to bring up this larger issue up with Ms Braly within a few days. In the meantime she is going to research what is going on here and get back to me in a few days.
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1/24/12
Good afternoon Mr. XXX,
Thank you for taking your time and speaking with me this afternoon. Please know that I am working on this issue and I am committed to getting this resolved. I will be in touch with you next week.
Thank you,
Renata Brown
EBS Coordinator
WellPoint Inc.
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1/25/12
Note to self.
I did a little research last evening into Wellpoint and Ms Braly. Here is what I discovered.
Angela Braly's compensation:
Ms Braly is #147 on Forbes' list of top executives compensation
Salary $1.14M
Bonus $2.71M
Other $5.63M
Total Compensation $9.49M
Total value of WLP stock owned $25.5M
This does not include options that have not vested yet. Her compensation is down from 2009 when she made over $13M in total compensation
There is information on a dispute between Wellpoint and Express Scripts.
When Wellpoint sold Next Rx to Express Scripts it entered into a 10 year agreement with Express Scripts to provide PBS (Pharmacy Benefit Services) to Wellpoint. Wellpoint represents 30% of Express Scripts revenue. There is not much known about the agreement.
Yesterday Wellpoint reported fourth quarter earnings:
Net income fell to $335.3 million (96 cents per share) vs. $548.8 million ($1.40 per share) a year earlier, a decline of 38.9% from the year earlier quarter.
Yet,revenue rose 4.8% to $15.32 billion from the year earlier quarter. Analysts were expecting $15.41billion.
Adjusted net income was 99 cents per share, short of mean estimate of $1.11 per share analysts were expecting.
Wellpoint stock dropped by approximately 6%, costing Ms Braly about $1.5 M in stock value that she holds in Wellpoint. This is not to mention the decrease in value of the options she may hold.

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1/31/12
Note to Self summarizing telephone call with Renata Brown of Wellpoint.
This was Ms Brown's follow-up on her email of 1/24/12 wherein she indicated that she was going to follow up on the inconsistencies that I had pointed out to her in my emails and letters.
She started off saying that for the first time she got the people at ES to admits that they were wrong. The stories that they have given are impossible to have occurred as they have related them. With regard to the faxes with Rxs from Drs. that they said they never received, yet somehow have attempted to fill, they now admit they had received those faxes. With regard to the question of the refill date being wrong they admit that I was right, and that when they advised me that they could change it, they misspoke. They can't change the date, even though it was in error. Ms Brown will continue monitoring the filling of our Rxs to make sure they are filled correctly into the future. She feels very uncomfortable with the performance of ES. That everything in my emails and letters has turned out correct.
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2/2/12
Note to Self
I was wondering how much negativity is really out on the internet about Express Scripts. It doesn't take much to find the reams of comments. Just Google "Express Scripts Complaints"
Look at this site:
http://www.customerservicescoreboard.com/Express+Scripts
Pay particular attention to the dozen or so comments from current and former employees.
Here is another blog dealing with the hell of Express Scripts:
http://editor-mom.blogspot.com/2005/11/inside-hell-of-express-scripts.html
Express Scripts has got to be stopped.

******************************************************************************
2/6/2012
Interesting news today about Express Scripts (ESRX).
First, we have that the FTC will oppose the merger between ESRX and Medco Health Solutions. Hooray! See this link:
http://www.bizjournals.com/stlouis/blog/2012/02/reuters-ftc-will-oppose-express.html
The second tidbit is that ESRX is apparently going to the bond market for a second round to raise cash for the purchase of Medco. See this link:
http://www.bizjournals.com/stlouis/news/2012/02/06/express-scripts-issues-debt-in.html
The result of these two pieces of information have dropped the stock price by almost 5%.
**********************************************************************************
3/15/12
Ms Brown:

We have had the pleasure of not communicating over problems at Express Scripts for almost two months now. But, alas, the honeymoon is over, again.

Let me bring you up to speed for the latest round.

I called the Express Scripts reorder line for the now infamous Rx for my wife today.
If you will recall we had that Rx which was initially written on 12/21/2011 and filled on 1/4/2012.
You will also recall that this very Rx has the curious notation on it that it may only be reordered after 8/31/2012 in spite of the fact that the Rx expires before that on 6/12/2012 and the natural progression would lead one to believe that it should be available for refill on or around 3/7/2012.

You will also recall that there was at least one of the other "lost" copy of this very same prescription for this drug that was on file at Express Scripts, and probably more than one.
After some initial confusion, I was told by the ES patient advocate that a drug refill was sent to us on 3/11/2012.
We have not received this medication yet.
Further, it is noted that we are NOT on auto-fill and they could not determine why it was allegedly sent to us.
Furthermore, I was told that the Rx was NOT the former Rx that was refilled, but rather one of the other Rx's that they had on file.
Additionally, as I have been told, we will have one additional opportunity to refill this new Rx, if we do it before 6/21/2012.
Thereafter, my wife will be forced to get another Rx from her physician.
Also, I was told that the $70. co-pay for the Rx that we did not auto-fill nor order was charged to our standing credit card number on file with Express Scripts.

So, one question that could not be immediately answered was how did this Rx get ordered? I thought that perhaps you had interceded. Is that the case?
Next, and I hope you do not consider this a picky point, but on January 5, of this year in an email from me to you I said,

"I hereby put ES on notice that we do not want auto refill on Rx's, nor do we want auto notification of Rx's that are in need of refill.
Neither of these were ever elected by us. I know that last round in 2011 it took considerable effort to get these unapproved services stopped.
Please do not have ES reinstate these features unless you receive written notification from us to the contrary, signed and notarized."


Now, I know that I was told that we were not on auto-refull, but a refill without an explicit call from us in my book is still an auto-refill. Further, since we explicitly did not authorize the filling of the Rx the charge to our credit card was unauthorized.

Also, I find it curious that in the past those Rx's would be good for an entire year, but who knows what the rules are now.

One more point. As you are probably aware, as a result of a court ruling there will be a generic version of ZZZZZ available starting sometime in April. In case you are not familiar, Cephalon, came out with YYYYYY in an attempt to manipulate the market for this class of drugs so that people now using YYYYYYY would not be switched by their Health Services Providers to the generic ZZZZZ. And, of course, Teva, the main generic Pharma company bought out Cephalon.

What is the position of Wellpoint/Empire Blue Cross/Express Scripts with regard to the use of ZZZZZZ in the plan we are in after the date that the generic drug comes to the market next month? I presume that the price will be lower for you and us. Both the physician community and the patients seem to be in concurrence that the ZZZZZ works better than the YYYYY anyway.
Obviously, if the ZZZZZZ will be available in the plan, we will instruct my wife's physician to write a script for it instead of the YYYYYY.

Regards,

**********************************************************************************
Good afternoon,

Yes, I do recall your wife's prescriptions for YYYYY. The prescription that was filled with the date of service of 03/06/2012, Rx number xxxxxxxxxx, was one that I explained was in that "Tickler File" and would be automatically filled. Did I misunderstand that we were going to let this prescription auto fill since it was set to do so?

The prescription that is in-transit shows on the USPS website as being picked up on Monday, March 12 and currently shows as out for delivery for today. The tracking number is: ttttttttttttttttttttttttttttttttt.

The previous prescription # wwwwwwwwwww was automatically inactivated when the newer prescription was processed. There is an additional refill on the current prescription #wwwwwwwwwwwww which can be used on the next fill. Prescriptions for controlled medications are only valid for 6 months from the written date, which in this case would be 06/21/2012.

Express Scripts has advised that neither you nor your wife have any prescription currently enrolled in the Auto Refill Program. They have also made notations so that no one will ask if you wish to enroll when you are placing refill orders, since this is the usual protocol. It has also been confirmed that both of you have opted out of the automated reminder calls and your contact preference is set to "Do not Contact".

In reference to the generic version of ZZZZZZZZ and how it relates to your plan, I have referred that question to the Director of Pharmacy since the formularies have not yet been updated. I will let you know when I have additional information.

Thank you,

Renata Brown
EBS Coordinator
WellPoint Inc.

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3/16/12
Ms Brown,

Always a pleasure to hear from you.
I notice you have a new secure email procedure for dealing with messages. Unfortunately, with this new method there is no record of the emails you are sending me that I can keep in my records with this technique. Consequently, I will just copy the responses I get via your secure email into my next email sent by regular email like I am doing here. That way I can easily access your responses without having to rely on the secure email at your site retaining my records.

My understanding of our previous conversation was that I was going to call to order the next refill. We were hopeful that I could still use the old prescription. Also, it was made quite clear to me yesterday that the Rx that we should receive today was not generated by auto refill.

No matter, I think we understand each other. We do not want the automated systems at ES mucking up what would otherwise be a very smooth flow of medications from ES to us when it works.

As I now understand the situation, on or about June 10-15 I will call again call ES and order the next refill of this drug, assuming we have not switched over to the generic ZZZZZZZ by then.

Thanks for your input and I await the response on the disposition of the generic ZZZZZZ by the plan.

**************************************************************************************************

3/22/12
Hi Mr XXXXXl,

I hope you are doing well today. I apologize for the security issue. We changed from an old version of Microsoft to a newer version called Cloud, but I was not aware there are problems until your email.

The Director of Pharmacy has advised that the soon to be released generic formulation of ZZZZZ is projected to come on the market as a multisource drug (a drug produced by more than one manufacturer). We expect Express Scripts to classify it as a generic and therefore it should be added as a Tier 1. A release date has not been confirmed, and until that happens I cannot be sure of the copay.

I will watch out for notices on the medication and let you know when I hear something more concrete.

Thank you,

Renata Brown
EBS Coordinator
WellPoint Inc.
***************************************************************************************************************

4/17/12
Note to self
Checked on the status of an order for Rx's placed with Express Scripts about a week ago on the automated system. The system indicates that the shipment was sent on 4/14/12 and was to arrive on 4/16/12. Since it had not arrived on 4/16/12 I then spoke with a representative who explained that the shipment was, in fact, scheduled to arrive on 4/18/12, contrary to what the automated system reported. We will see what happens on 4/18/12.
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5/1/2012
Note to self
Three Rx's.
Two faxed in by the doctor. No record of their existence by Express Scripts. Time to redo that. How often does this have to happen?
The third Rx is for the generic version of a drug. It is on the market and contrary to the email from Renata Brow of 3/22/12 she did not notify me.
Isn't it interesting, when it is a patent drug that is expensive they require preauthorization and put you through hell, but as soon as it becomes a generic and is cheap you don't even need authorization.
In any case, there is total confusion between the doctors, pharmacies, Express Scripts on how to handle this one. Rules are changing daily. We wait and wait for fulfillment. Who cares if the patient needs the drug. Let the powers fight it out.
********************************************************************************************
5/4/2012
Note to self
Called Express Scripts to see if the retransmission of the Rx's was received. Automated system indicates that they received both and have already shipped them. Great. Only problem is that one of the two Rx's is recognizable. The voice on the automated system is garbled on the new one.  Spoke to a human. They cannot utter the name of the drug. The patient must tell them the name and they will confirm it. Catch 22. Spoke with a supervisor.
I pointed out the inconsistency. The automated system gives out the name, but a human can't?  It is against the law she said.  The automated system was not supposed to give out the name in the first place.  What a circus.  I wonder what the penalty is for violating the law?
**************************************************************************************************
7/1/12
I pulled the plug on Empire and Express Scripts. Went to United Healthcare with Medco for Rx fulfillment. I know that Express Scripts has bought Medco. Hopefully I can last a while with some better service until Express Scripts screws it up with their wonderful management capabilities.
**********************************************************************************

8/29/12  There is an article today in the Indianapolis Business Journal by J K Wall entitled: "Departing CEO Braly due to get $15M exit package"  which is a scathing testimony to her tenure at Wellpoint.  Some of the on-line comments about this article are even more scathing.  For example, one comment states:




Confusion Across the Board
After reading the posts here, I think people are asking very basic questions regarding executive compensation and the fact that many people are working very hard just to cover their family's healthcare costs. Fifteen Million Dollars sounds more like an Indiana Lottery Winner than a fired CEO. Maybe the Board of WellPoint should allow people to buy a chance at being CEO for a year. I believe that WellPoint could raise millions, and maybe, just maybe, an average person from an average family might actually perform better than another healthcare insurance carpetbagger.

The other comments are good reads too.

There is another post on the same date on Bloomberg by Drew Armstong entitled:

"WellPoint’s CEO Braly Resigns Amid Shareholder Criticism" which you can click on also.

I note that the stock price for Wellpoint increased by almost 7% the day it was announced that she was stepping down. 
Armstrong notes "During her tenure as CEO, Braly became a high-profile foe of President Barack Obama’s health-care overhaul"

Let's hope that corporate America has learned their lesson with her and keeps her out of the helm of ANY substantial American company from hereon out.

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11/21/12
When I called Medco today I was greeted with the Express Scripts notice. How wonderful.
I needed to talk to a real person in order to fulfill the Rx.  After 10 minutes of trying every conceivable way to get to a human I gave up and called United Healthcare. They gave me a different telephone number. Nice.

I'm sure I will be adding more posts to this blog now that Express Scripts has come on board.
It was actually nice to have a responsive mail order pharmacy for a while.




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