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

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!

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

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.

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.