- By Milt x_Zall
- May 29, 2000
If you're like me and are enrolled in the service benefit plan run by Blue
Cross and Blue Shield, keep a close watch on your prescriptions.
This plan uses Merck-Medco Managed Care LLC to administer its mail-order
prescription drug plan, which is pretty good — $12 for a 90-day supply of
a generic drug and $20 for a 90-day supply of a brand-name drug. But some
of its practices are likely to drive you up a wall.
For instance, here is what happened to me recently.
My doctor switched the medication I take to lower my cholesterol. After
two weeks, he concluded that the new medication wasn't working and gave
me a prescription for the medication I had been taking before the switch.
I sent the new prescription to Merck-Medco to fill.
After about 10 days, when the medication didn't arrive, I called to inquire
where it was. The service representative told me the computer had "canceled"
the new prescription because it duplicated the medicine I had been taking.
I told the representative that I was not taking the old medication anymore,
which is why I had submitted the new prescription.
I asked to speak to a pharmacist and explained to him that I wasn't taking
both medications. He was quite understanding and blamed the computer for
When I asked the pharmacist what right the company had to cancel my prescription,
I didn't really get a straight answer.
I told him, "I understand that you need to manage prescription drug
utilization, and if it appears that two drugs for the same condition are
being used, you have to investigate. But where do you come off canceling
a prescription my doctor gave me? That's not yours to cancel — it's my property.
If you don't want to fill it, OK. But where does the company come off canceling
Although the pharmacist immediately recognized that the computer had made
a mistake, he couldn't simply undo what the computer had done. The mail-order
prescription service is just like the government — when the computer cancels
a prescription, it's canceled. The only option is to call the doctor for
a new prescription.
So I asked the service representative, "When will I get my medication?"
He said, "Right away." I asked, "When is right away?"
The service representative hemmed and hawed, so I said, "Will you call
me and let me know?" I was told that he would call.
Well, for three days in a row I received a call late in the day informing
me that my medication wasn't shipped out that day but that it would be shipped
out the following day.
I haven't gotten my medication yet, but a senior representative (whatever
that means) told me that he was going to have the matter investigated.
When I called my local Blue Cross plan to complain, the representatives
there told me that they only handle medical claims and if I had a problem
with prescription drug claims, I should call Merck-Medco. Who said the private
sector is so great?
—Zall is a retired federal employee who since 1987 has written the Bureaucratus
column for Federal Computer Week.