Diabetes Self-Management Blog

I’ve written before about some of the time-consuming chores that accompany managing my Type 1 diabetes. It’s never-ending, and so when I have a month or two where things go smoothly, months devoid of the runaround, be it the doctor’s office or the blood lab or phone calls with insurance providers and health-care management people or multiple monthly trips to the pharmacy, I don’t take it for granted. I bask in the lack of to-do.

Lately, though, it’s that last one — going to the pharmacy to refill prescriptions — that’s been difficult for me. Yes, readers, some of you have commented before that I should look into mail-order prescriptions or 90-day refills on my scrips. I noted your helpful advice, but I refused to take action at any time these past two years.

Why would I deprive myself of the ease of prescriptions delivered through the mail and instead drive two miles, one-way, at least two, maybe three times a month? Because, well, I enjoy the face-to-face, and, as I’ve also written, I like the process. Oh, and because we — or at least I — tend to stick with those who brung us, be it a health-care provider, an insurance company, a doctor, or a pharmacy. The bureaucracy that surrounds, engulfs, ensnares, and is unavoidable in the U.S. healthcare system is daunting enough the first time around. Why switch for switching’s sake, unless you’re one who enjoys the labyrinth of automated phone systems and you tend to be masochist for filling out form after form after form?!

So, unless, I experience an egregious error in care or service, or a wonderful alternative presents itself, chances are that I’m usually locked in to what I started with.

To date, I’ve had no complaints with the Rite-Aid pharmacy that fills my prescriptions. Yeah, finding half an hour to make the trip to the pharmacy can be annoying, but when I go in, they know me by name, chat with me, refill the prescriptions promptly, and do whatever they can to expedite my time in the store. It’s my own little pharmaceutical Cheers; I mean, I looked forward to going in and seeing them, one in particular because she was always in a good mood and happy to talk about any concerns I had regarding my diabetes care.

But not all good things last, and now I’m bailing on Rite-Aid — I’m in the process of leaving them for another pharmacy. And as cheesy as it may sound to say this about a corporation, I feel a bit like I’m betraying a good friend. You see, Walgreen’s Mail Service offers something that Rite-Aid doesn’t. They’ll send me my prescriptions. In the mail. To my home.

Just like many of you have said.

In Rite-Aid’s defense, they do do automatic refills of my scrips. Two months ago, I switched to that system with the hope that I could make only one trip a month to pick up the three main scrips that I take, which were on a 30-day refill schedule. I thought I’d try that before asking my doctor for 90-day prescriptions, which I could use at the Rite-Aid or with the Walgreen’s service.

Rite-Aid told me that I’d get an automated phone call when the prescriptions were ready. Sounds great! I also understood that things were synched up so that all scrips would be ready at the same time.

I was wrong.

Ten days ago, I got an automated phone call that my order was ready and that I had until February 26 to pick it up. A few days after the call, I went to the store, made the small talk, and then, when the tech came back with my prescription, she came back with one prescription. A prescription. Uno. Not the three I wanted to get during that trip.

Not what I was expecting.

She told me that those hadn’t triggered to be refilled yet. I asked if I could get them refilled, but the insurance wouldn’t cover it yet. After more conversation (friendly, not agitated), I learned that it there’s no way, really, to synch them up.

So, basically, I’d have to go back in a week or two to get another scrip, then in another week or two, pick up another scrip, and a few days later get the other one that triggered, and on and on ad infinitum; lather, rinse, repeat, repeat, repeat.

Moving to Walgreen’s Mail Service was a decision I didn’t make lightly. I knew the transition would be fraught with hurdles, filled with forms, faxing, phone calls, and frustration. I also foresaw an uneasy period during which I wouldn’t know from where the next few weeks’ worth of medication would come. Okay, six days left of this drug, and about 10 days of that one, and I could probably stretch out the insulin just a little while longer and not change my reservoir until I’m down to the very last drop…

But what if I do run out? Will the supplies reach my mailbox in time? Yes, I’m sure that my scrips at Rite-Aid won’t just fade away, even though I’ve canceled the automated refills. The truth, however, is that I don’t want to go back there now and face them. What if they know? What if they call me out? Why did I break up with them? They’ll be sorry to see me go. I’ll have momentary regret. It’ll be tough.

Oh, it’ll be fine, really. I’m just in the midst of a tough transition. Soon, though, the initial wrinkles will get ironed out and I’ll settle happily once more into pharmaceutical monogamy.

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Comments
  1. Dear Eric,

    I know somewhat of what you went through. I was with Wal Mart for several years. Not only am I diabetic, but I also had a liver transplant, which meant several drugs. Now I’m down to only two for the liver, but had two heart caths done just a year ago and am on some heart meds. Because of the long lines at Wal Mart, I switched to CVS. Along with my regular meds, they also slipped one in on me that had my name on it, but was not mine. After taking it for 6 days, I realized it wasn’t mine and took it back. They were very friendly to me and gave me a $25.00 gift card. I guess that’s better than being sued!!! I just switched to Humana which has mail service. I just may go that route. Like you, my meds are stretched throughout the month, with several trips to the pharmacy. I am seriously looking at the mail now!!!

    Posted by Tom S. |
  2. Thanks - I too feel guilty about leaving my pharmacy, locally owned–not part of a chain, and the pharmacist has diabetes and has been a huge help to me.

    But I’m leaning towards mail order - cheaper I think - 90 day supply - and comes to my home.

    Posted by JodyHepler |
  3. I’ve had very similar feelings about my pharmacy: a local privately owned one 1 1/2 miles from my home. However I need 19 prescriptive medications per day and 18 supplemental meds per day. I was averaging $300 a month OVER what my insurance paid. This will hopefully be decreased by switching to a Express Scripts mail order account. This is the month I am trying to get my docs to fax in new 90-day scripts to the new ‘pharmacy’. I’m guessing my injectible meds (insulin and Byetta) will still stay with my local pharmacy. I’ll be glad when it is all settled.

    Posted by Rebekah |
  4. I have also been struggling with this problem. I hate it when I go the day before my drugs are gone and my insurance co won’t pay until the next day. I like the idea of my present pharmacy knowing everything I take and looking out for me in that respect. I used Wal-mart until it dawned on me that no matter when you go in there at the one near me its always a 20 minute wait. No matter what. That’s so you can roam around the store and pick a “few” items that you did not know you needed. I feel the same loyalty to CVS that Eric felt to his pharmacy and I like the fact that I can go in and browse or I can use the drive-thru if I don’t feel like getting out of the car. The mail order is tempting for a lot of reasons and in the future I may give in to the call but as of right now I am happy where I am. I love the fact that my pharmacy offers online service too. I can jump on there while paying bills or just messing around and order up my meds but they also have the automatic refills too. It’s hard to find a pharmacy that you really like and I understand how you feel. Maybe in the future they will offer this service and you can go back home.

    Posted by Cathy |
  5. Being retired military, I use Humana’s Express Scripts but only as a last resort. I have had so many prescriptions messed up due to people not followingthrough with what was discussed on phone calls, etc. My doc and nurse also very much dislike them because they can never get anything right the first, second, or third times. It always takes at least 4 tries!

    I have even been sent insulin that I could not use (wrong type) and couldn’t send back but was told I still had to pay for. Fortuneately, being a military retiree, my co-pay is low. I ended up donating the insulin to a local community clinic.

    Anyway, I’m sticking with my local Medicine Shoppe!! What a great bunch of folks. They always find time when I have questions be it over the phone or in person. What I can’t get through my retirement benefit (TriCare at a local military pharmacy), I get through the Medicine Shoppe.

    Posted by jiminpcola |
  6. I don’t do mail order because I can’t totaly trust that the insulin will maintain refrigeration the whole way. Just oo much of a drag finding out the hard way that the potency is inconsistent. Much easier to trust Rite-Aid on that. It was easy to synch my four daily pills to the same schedule, the pharmacy made a call to the insurance company. Even if it wasn’t, I could simply pay out of pocket one time to synch them.

    Posted by Peter Mead |
  7. Hi Eric,

    I have an opinion on this issue, in fact a pretty passionate opinion! In the interest of full disclosure, I am both a diabetic and an independent pharmacist. My Dad has owned our pharmacy for 49 years. We have come out in the middle of the night, traveled many miles to pick up and deliver needed medicines and logged many counseling sessions, usually at no extra charge to try and improve the health of our patients. We have administered glucose tablets to patients who come in hypoglycemic and tested and offered counsel to many patients with sugars in the 400+ range, even to the point of offering to take them to the doctor or hospital. I believe it is WRONG for insurance companies to force their customers to use mail order only and if there is a choice, to discriminate against small businesses like ours by offering a “better deal” by way of lower mail order co-pays and greater days supply. I say lobby your insurance for a level playing field with local pharmacies and then compare the service! Will your mail order company give you strips if your medicare deductible has not been paid? Our little pharmacy will spot you the strips while the paperwork is sorted out, as we do NOT want you to be in a position of not being able to test yourself. Will your mail order company sit down and demonstrate new machines, lancet devices, etc? How can someone who you do not have a personal relationship with offer better care than someone who has known you and the extent of your disease? And in our case, if picking up your prescriptions or strips is a problem, then we WILL deliver at no extra charge.

    Diabetes is a life changing disease that requires constant monitoring. We as diabetics must be our own advocate. However, research documents that the healthcare team around the diabetic also play a very important part in the patient’s outcome. Surround yourself with the best!

    Debbie,R.PH.

    Posted by grovedeb |
  8. Hi Eric and all,
    I’m one of those people who want my meds locally. For one thing, I live in a rural area. My mailbox is out by the road and in the midday full sun in a hot Texas summer. I don’t want meds sitting there overheating. Its bad enough having to get my strips that way!

    I also like it that my pharmacist comes to ask, “have you raken this before?” every time I get something new, then explains side effects I need to watch for, cautions, etc… even though I’m fully capable of reading the insert myself. I like that he looks out for his customers.

    Change to mailorder? Not unless I’m forced to do so. Its the insurance companies fault I have to go so many times a month, not my pharmacist’s.

    Posted by Ephrenia |
  9. Eric,
    Well, I’ve gone the opposite route from you. I was utilizing Express Scripts for my 90 day rx(s).
    This is my rx plan company through my insurance.
    Now, they are no longer financially competitive and so I’ve gone the local route, with no real problems at local pharmacies.
    The only current rx I’m getting with ES is for my d strips, which are still the best (deal) I’ve found.
    However, I’ve been having a real situation with my bp med. I had been on Diovan for years with no problem. ES decided they would double the price, moving it off recommended formulary list. I was encouraged to replace with lisinopril.
    Ok, what no one said was, diovan and lisinopril are in two different classifications of bp meds and handle lowering of bp differently in the body. I went on lisinopril, and have unfortunately developed the (common) side effect of uncontrollable coughing. (Great in those interviews).
    So here’s an insurance provided rx program, that really is not so great for the consumer. But I’ve decided to live with the lisinopril, knowing that as I purchase the lisinopril locally, I’m paying less than half (90 day supply) locally than their generic price would be.
    Talk about a situation raising my bp??? Comical, if it wasn’t so sad.
    Sandi

    Posted by Sandi |
  10. Eric, Debbie, etal,
    Ok, one other thought. I totally agree with Debbie’s passion on this subject. I have an rx for a compounded med. I called Express Scripts to find out if they “compound” not indicated on their website, and tried to get a price.
    I was eventually told that “there were too many variables” to give me a price. They would let me know when they received my rx. I said no, thanks, there are only two components making up this med, and I would exercise other options.
    Componding pharmacies are not that common, but I was able to locate an independent pharmacy that willingly filled my rx and submitted to ins. ES does not prefer retail rxs (obviously) and for 2 months, all was ok, just paid my standard generic prioe.
    Then I get the letter from ES telling me they would no longer support my retail purchases of this med, and I would have to submit directly on a 90 day basis to them.
    Guess what, no way. I called my local pharmacy explained the situation, and they said they’d be glad to fill the rx at the same copay I paid ES, and would no longer submit to insurance.
    Yea, for the independents!
    Sandi

    Posted by Sandi |
  11. Oh have you hit the nail on the head! I have found no cure for the frustration Medco (cheapest mail order I’ve found accepting our insurance and 90-day supplies) has caused! Well, between the doctor’s staff and the Medco automated voice folks, and those calling back with such a thick foreign accent I cannot understand why they say “to speak in English press 1″ when they clearly cannot even understand English themselves, I’m at my wits’ end. Case in point: dr. allowed me to titrate my insulin to achieve normal fasting and postprandial readings (and not venture way outside of normal diet). His staff called me to verify amount needed. I had sent Medco a complete spreadsheet with all info on it for all my meds, schedules, new amounts, etc. to streamline the process. Don’t do this! They don’t read what you send, apparently. Then Medco sent the Lantus and Novolog too early when we were out of state. It sat in the sun for 3 days, heating up. After several phone calls and being run round Robin’s barn, I was assured my meds would be re-shipped free. Medco called to verify delivery intent and that was done. But when I opened it up, it was the OLD insulin dosages, so I was shorted considerably. I’ll have to return to the dr, go thru all the mess with Medco, and I’m about to blow a gasket. I’ve done everything by the book but still they do not behave like local pharmacists. I agree, stick with local pharmacies, but insulin costs keep many of us in bondage to the price warring bigger (albeit incompetent) entities. Time to bite the bullet I guess.

    Posted by Kim |

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