By ARTHUR VIDRO
By Arthur Vidro
On March 5, I received a letter from Anthem, my health insurance provider via the Affordable Care Act.
It stated: “With your plan, you have several ways to get the medicine you take on a regular basis. It is your choice, but you need to let us know what you’d like to do, or your costs will go up.”
It explained my three options.
First, switch to IngenioRx for home delivery of my drugs and get 90-day supplies sent my way with free shipping. Second, switch to 90-day supplies and pick up the medication myself at a CVS pharmacy. Or third, get a 30-day supply at a time at any network provider.
IngenioRx is the pharmacy benefit manager recently created by the partnering of Anthem Blue Cross and drugstore chain CVS.
Insurance providers hire (or create their own) pharmacy benefit managers, which negotiate with drug manufacturers and distributors. They determine what drugs are covered favorably, what drugs are covered unfavorably, and what drugs are not covered at all.
Each pharmacy benefit manager keeps a chunk of the profits for itself, thus elevating even more the final cost to the consumers.
For the drug listed on the letter, I had been getting 30-day supplies at the local Sugar River Pharmacy.
The letter also contained this ominous paragraph:
“If we don’t hear from you, you will have to pay the full cost for this medicine until you contact us.”
To me, that is threatening language. It is saying a person who each month sends a premium for health insurance to the company will be cut off from all pharmaceutical benefits unless they act. The default — the customer’s doing nothing — results in disaster.
That is outrageous.
Those $10, $20, or $50 copays you have could easily balloon to hundreds of dollars apiece if no insurance is applied.
This letter reminded me of bygone days when organized mobs exercised rigorous control over commerce in their territories.
A mobster might visit taverns and explain to the proprietors that it would be in their best interest to sell liquor provided by the mob and not to stock competing liquor from other suppliers. Most proprietors complied. Those who didn’t comply had the contents of their business smashed, or were given personal injury as a persuasion tactic. It was free choice, of a sort.
The letter from Anthem concluded with, “You can also call any time at 833-203-1739 and let us know what you’d like to do.”
I dialed the number. Useless. That number only serves folks who already have enrolled in IngenioRx or who wish to enroll. But I didn’t wish to enroll.
I have nothing against getting 90-day supplies at a time, especially if it saves money for the insurance company and they pass a chunk of those savings on to the consumer.
But I wouldn’t welcome home delivery of medications (though I admit it can be a blessing for housebound invalids). I don’t want to worry about when it might arrive. Plus, I prefer speaking face to face with the people who fill my prescriptions. It facilitates getting questions answered, and if an error or misunderstanding crops up I can get it fixed right away, before taking possession of the merchandise.
Unfortunately, folks who wish to continue the status quo of visiting Sugar River or other neighborhood pharmacies and keeping the money in the community, have to jump through hoops. I had to dig up the insurance card, fish around for a magnifying glass, and read the fine print to find the pharmacy division of the insurance giant.
Naturally, the phone number for declining to enroll was absent from the letter.
At least they answered the phone quickly.
But the phones are answered by sales pros whose job is to convince you to do things their way. Minute after minute, they refused to take no for an answer. In the end, they allowed me to remain with my little neighborhood pharmacy.
But I had to work hard and invest much time just to keep the status quo.
Yet, I can picture folks who are gullible or too eager to please others, parting with the pharmacy of their choice, just because of the threatening letter or the insistent sales pitch.
These tactics are not just about IngenioRx. A few years ago, when Anthem used Express Scripts as its pharmacy benefit manager, I had to go through the same rigamarole.
I wonder if small neighborhood pharmacies are losing business to these huge competitors that are using such scare tactics.
And I hope folks who don’t read all their apparent junk mail don’t lose their pharmacy benefits entirely just because they remained ignorant of the changing rules.
If you have consumerism questions, send them to Arthur Vidro in the care of this newspaper, which publishes his column every weekend.
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