Do companies really hear blogs barking?

by Karoli on September 20, 2006 · 11 comments

Via Digg — Evidently some do.

Unfortunately Caremark doesn’t seem to be one of them. Here are some recently published complaints about them at ConsumerAffairs.com. They’re also linked in this story (the full story which mentions Caremark is living in the Wall Street Journal’s walled garden, so I’ll link to the abbreviated one published in the Pittsburgh Post Gazette instead).

In a nutshell, employers are discovering that many third-party administrators are in the pockets of the insurance companies and are compensated generously for recommending a change to Caremark. Evidently Caremark figures that it’s more profitable to pay the middleman, even when there is a conflict of interest, than it is to honor their PBM obligations and cover prescribed medications.

An excerpt from the WSJ article:

… It is another example of how health-care middlemen can reap profits even as … Strategies says the firm received revenue of $629,012 from a PBM, Caremark Rx Inc

Other Caremark news of note:

Litigation against Caremark for backdating stock options goes forward. (Follow the money on that one)
A man is fired after his employer accessed his Caremark medication records and discovered a prescription for an anti-anxiety medication.
Caremark set the California precedent for holding board members civilly liable for criminal acts, which could come back to bite HP’s Board in the butt with regard to their recent pretexting shenanigans.
Caremark’s 2nd Quarter profits were above expectations, largely because of their insistence on denying coverage for prescribed medications to consumers who are NOT Medicare or low-income subscribers.

Caremark (NYSE: CMX) was one of the most recent companies within this group to report. CMX generated second-quarter profits of 57 cents per share, two cents above expectations. Net revenues rose 15% primarily because of increases in mail and retail sales. Medicare Part D played a role in the growth, though the company noted that it saw “several major generic introductions” this year. (The cheaper cost of generic drugs makes them more affordable to consumers and more profitable for medical insurers and pharmacy benefit managers.) Citing both business momentum and the impact of share buybacks, CMX raised its guidance for full-year earnings per share to a range of $2.37 and $2.39 per share, from $2.29 and $2.35 per share. The majority of the 18 covering analysts raised their projections in response, causing the full-year estimate to rise by four cents to $2.38 per share.

As for me, I am about to fork over another $400 for Sticks’ meds for the last quarter of the year. I have exhausted my Tier II appeals and am about to go back for another round, but he still has to have the meds.

I think that means this blogger will keep barking.

Technorati Tags: caremark, PBM, sleazy insurance practices

Tagged as: ADHD, Business, Health, Insurance and Benefits

J.

….here’s a few ideas for you, if you’re unhappy with your insurance or your drug coverage:

Stop using it…
Use another insurance company that doesn’t contract the company that you don’t want to use…
Pay the actual full cost of the medication instead of the rate that you’re getting it at…

It doesn’t do any good to sit and complain about a company that doesn’t choose what you can and can’t have. The contracting company -does- agree to what’s on the list and what’s not, so why not write about how crappy the corporate deciders are as well, instead of singling out one company.

Caremark isn’t even an insurance company, and it’s NOT just another section of BlueCross/BlueShield. It’s a seperate company altogether.

You want results? Talk with the people that approved the plans that Caremark is given. Other insurance companies/other employer groups have incredible insurance, and they go through Caremark as well. Hell, my insurance is great, I’m going through Coventry (who uses Caremark as their PBM on most, if not all, of their plans), and I don’t have the trouble that you’ve got with yours.

Your doctor is great, that’s wonderful….mine’s not. The only reasons I go to him is because he’s in my “network” and I’m too lazy to drive out to the next town to see another one that I might like more…and because it doesn’t cost me as much. If I had that much of a problem with him, I wouldn’t go. Yes, it would cost me more, but I’m not stubborn enough to fight against my insurance company (Coventry) because my friend has a better plan than me and pays less for their doctor visits.

Yes, INSURANCE as a whole sucks. But, you know, it saves -you- money more than you know. If you don’t like using it, then don’t. Don’t use it at all. Ever. Just pay your doctor out of your own pocket, along with the pharmacies that you visit….if you don’t have the insurance plan that says you can’t have a medication, then you can……..and……….there you go.

I visited a few more of the posts on here….saw the Caremarkrxsucks.com, and had to laugh. Most of the links aren’t relevant to your insurance plans, and most of the lawsuits that are so “pointed out” list OTHER PBMs as well. So when listing these as references to show why Caremark sucks, why not list the ones where MedCo sucks? Or where other companies suck?

Get your own insurance, pay for it as an individual, and then bitch when they tell you you can’t have something. Because (I’m sorry), if it were actually Caremark making the decision, your employer (that pays SO much for it) would drop them like a hat. Caremark is contracted BY the companies that YOU or your HUSBAND work for…not the other way around. Complain to your HR, your Benefits Office, and ask them who decides what medication you can and can’t get…..then bitch at them when they tell you that they’re not switching, and see what they tell you.

If they switch, then great….you can go through the whole process of being happy, then finding out that your insurance sucks all over again.

Useless arguments…like “McDonald’s doesn’t make the hamburgers the same as Burger King! AND IT COSTS ME MORE!” …fuck it, then, don’t go there. If there’s not a BK within a hundred miles, well…then you’re just SOL. Make your own hamburgers…don’t go to McDonalds yelling and screaming about how they should do what they’re told to do…because you won’t get anything accomplished other than being frustrated, tired, and STILL without the kind of hamburger that you want.
http://drumsnwhistles.com drumsnwhistles

Hi J and welcome –

I agree with much of what you say, but here’s where we part ways:

No matter who contracts Caremark’s services, they are the designated gatekeeper, and they became the designated gatekeeper as a result of their own marketing strategies to employers and insurance companies. That marketing strategy includes a promise that they will lower the cost of prescription medications within the universe of health insurance plans.

I’ve had my own insurance as an individual. Guess what? If one can actually afford to pay the thousand dollars or so for an individual policy, that coverage will ALSO have a gatekeeper, usually Caremark. So that’s not really an option to get around it.

If a contract says “we will cover this medication if criteria are met” and the criteria are met but coverage is denied, it’s immoral at least, and illegal at worst. The contract I am bound to is the same contract that Caremark is bound to, yet they are not performing.

Caremark, Medco and the rest of these PBMS exist because they have promised to keep costs low to the insurance companies. They have a bottom line. They are enormously profitable. Those profits come on the backs of me, my employer, and every consumer out there who uses the health care system. That’s okay, too, as long as they perform under the terms of their contract. They don’t for me, and they don’t for many others.

Believe me, when they DO, I’ll be more than happy to say so right here, just as loudly as I have criticized them for not performing.

DnW

ps — If one hates McDonalds and goes to Burger King instead, they do it because they have that option. In this case, we don’t. Caremark is it. Period, end of discussion. So my options are to pay out of pocket or pay out of pocket. And that is why I write about them and will continue to write about them.

pps — oh, I forgot to mention that because Caremark has denied coverage to this particular medication, I pay full retail. No price breaks for me. So your argument about paying full retail instead of the discounted price doesn’t fly either.
J.

Your company has a choice, though, and that’s one of the points I’m trying to make.

If their dollars are being wasted and frittered, I doubt they’d be with the insurance that they’re with. Shouldn’t that raise some questions about your employers and those people that chose to contract with Caremark?

Wouldn’t it be more likely that through the course of the year, if it was a major problem, they’d switch?

If the answer to that question is no, then maybe you ought to have a talk with your employer, because Caremark is NOT the only PBM out there.
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http://drumsnwhistles.com drumsnwhistles

J,

Of course their dollars aren’t wasted and frittered. Employers are also in the business of making money and reducing employee overhead, which is why they will discount-shop their insurers and plans.

There are also some other limiting factors when it comes to Employer choice. If your employer is a national corporation with employees in many states, the insurance plan choices are limited to only those companies which offer coverage in all of those states.

The most commonly available insurer is Blue Cross/Blue Shield, who utilizes Caremark exclusively.

In many cases, the employer is using Caremark because the INSURER requires it as part of the contract.

Here’s the real problem — we are moving toward the HSA system of health insurance, which essentially shifts the burden of health care costs onto the employee and off the employer. It sounds good on paper until it’s time to deal with a catastrophic illness, at which point $5,000 and 70% coverage on everything over $10,000 doesn’t stretch quite far enough.

We’re going there because there is this assumption that there are not enough health insurance dollars coming into the system to cover the dollars paid as benefits. I don’t buy that, especially with record profits and bottom lines from the parties in the middle, like Caremark.

DnW
Jimbob

Caremark treats their employees like crap. Nobody in our callcenter got any Christmas bonus this year. Every other year they gave us a $25 giftcard but not this year. Also, the benefits are more expensive and are less beneficial. The company keeps taking away the perks we have all come to enjoy, and they pay newhires more than people who have worked there for two or three years! If you think Caremark sucks as a prescription provider, they suck even worse as an employer! They have had one of the best quarters ever, yet we haven’t seen another dime on our paychecks and the benefits are worse than last year’s.
Undisclosed4fearOfReprisal

In my case, a caremark billing center in phoenix handled a few of my prescriptions where I fulfilled my deductable. Later that same year a caremark billing center in Alabama charged me the deductable again. I paid all but the deductable with a well written letter describing why and attached copies of everything. Now they are sending me bills for that 100 dollars and listing it as 60 days overdue. This can become a serious credit concern. Caremark sucks. Call them and try to discuss anything, their employees are not very intelligent and care just want to finish the call.
CaremarkCustomersSuck

To all you customers who call and give us a hard time on the phone, I would like to say the following. We don’t give a crap about you. We just pretend that we do so we can keep our jobs. If Caremark did not have a “zero tolerance policy” for rude behavior, we would let you have it for giving us endless headaches all friggin day!

If you don’t like the service at Caremark, why don’t you just go to the local pharmacy and pay out of pocket. We’ll see how much you enjoy paying more for your meds. Service costs extra. Deal with it. Mail order pharmacies are SUPPOSED to give crappy service, that’s how they cut costs to the customers. If you are calling to complain, don’t bother. We’ve heard it all before a hundred times. Caremark is not going to do anything about it. No, the automated system is NEVER going to work right, so get used to it and quit calling and complaining.

Caremark dosen’t take care of their employees very well. The pay is crappy and the motivation to do a good job is non-existant. If you think I have a bad attitude, the attitude at Caremark gets worse the higher up you go, trust me on that. The higher up you go in Caremark, the farther your head goes up your butt. Mac Crawford’s head is so far up his butt that he dosen’t even know which way is up anymore.

Caremark simply dosen’t care and they never will, bottom line. They care about us employees even less than they care about you customers. They probably care even less about you than I do!
http://drumsnwhistles.com karoli

Thanks for your comment. The problem I have is not with the folks on the phone — it’s with the corporate culture, which is greedy and doesn’t care about employees, subscribers or anyone but lining the pockets of the big boys at the top.

Your comments about how they take care of employees says it all.
CaremarkCustomersSuck

You are absolutely right. I wouldn’t hate my job half so much if the corporation actually sought to treat both employees and customers fairly. Whenever I have to tell a customer something they’d rather not hear, it is most likely because Caremark Corporate or some other freakin department screwed up, not the folks in customer service. I just get so sick of cleaning up other people’s messes. Word to the wise, do NOT get a job at Caremark under ANY CIRCUMSTANCES! You may also wish to check out other blogs about Caremark, Medco, and ExpressScripts at sites like http://www.jobvent.com to see what other employees are saying!
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