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Friday, July 15, 2011

Fed up with the healthcare industry? Read one man's fight to do something about it!

A Reach Out Job Search News Op/Ed Guest Post
By Bruce Hurwitz, Ph.D

Photo Credit-Google Images
Have you ever felt totally frustrated dealing with a company that is supposed to be devoted to helping you?  Of course you have.  It happens all the time.  But how often do we say to ourselves, “Well, it’s not THAT much money.  Forget about it!”
This time I decided not to forget about it.  I want to do something about it and frankly I want to know if my (our) elected officials care.  So I am taking advantage of my radio program, and have invited seven members of Congress to join me to discuss the price of prescription drugs.  I have also invited my insurance provider, EmblemHealth, and their pharmacy, Medco, to participate.
Listen to this conversation that originally aired on Thursday, June 16 at 11:30 AM. After all, if it happened to one of us, it can happen to all of us. 
Here’s the full text of my letter, detailing what happened:
May 20, 2011
Senator Frank R. Lautenberg,  324 Hart Senate Office Building,  Washington, DC 20510
Senator Robert Menendez, 528 Hart Senate Office Building, Washington, DC 20510
Representative Steve Rothman,  2303 Rayburn House Office Building,  Washington, DC 20515
Representative Fred Upton,  Chair, House Committee on Energy & Commerce, 2183 Rayburn House Office Building, Washington, DC 20515
Representative Henry A. Waxman, Ranking Member, House Committee on Energy & Commerce ,  2204 Rayburn House Office Building, Washington, DC 20515
Senator Jay Rockefeller, Chairman,  Senate Committee on Commerce, Science and Transportation, 531 Hart Senate Office Building, Washington, DC 20510
Senator Kay Bailey Hutchinson, Ranking Member, Senate Committee on Commerce, Science and Transportation, 284 Russell Senate Office Building, Washington, DC 20510
Dear Members of Congress: 
This letter concerns health care, anti-trust issues regarding pharmaceuticals and interstate commerce. 
My health insurance provider is EmblemHealth which is part of GHI.  Their pharmacy is Medco. 
If memory serves, on May 8 I contacted my Pathmark Pharmacy to reorder two prescriptions, Simvastatin and Losartin.  Last month a 30-day supply of these drugs cost me, respectively, $4.12 and $15.27.  On May 9, when I went to pick up the refills I was shocked to discover that the price of the drugs had risen to $7.14 and $68.28, respectively.  This represents an increase of approximately 73% and 350%, respectively.  Both are generic medications. 
When the pharmacist explained that the prices were those given her by EmblemHealth and there was nothing she could do about it, I called to speak with a representative.  As it was late in the day, I was told to call back the next morning. The representative told me that the price of the Losartin had to be a mistake.  Ironically, as you will see, the problem was actually going to be with the Simvastatin. 
When I called the next morning and explained the situation, I was told that EmblemHealth had informed all pharmacies on April 17 that it would be raising prices on medications.  If I wanted to save money I would have to use EmblemHealth’s pharmacy, Medco, which would be able to provide me with three-month supplies of my medications at reduced prices. 
I asked for a clarification.  The gentleman reiterated that one price was being charged to pharmacies and another to Medco.  The first issue, therefore, is one of anti-trust.  Why should EmblemHealth be permitted to give preferential treatment to one pharmacy over another (or all others) as regards pricing, which is the only thing that matters when it comes to pharmaceuticals since all generics are identical regardless of manufacturer?   
I can understand wanting to promote their own pharmacy by offering special services, such as 90-day supplies of medications versus 30-day supplies, but not as regards pricing.  I am not an attorney, but isn’t this precisely why we have anti-trust laws?  Isn’t this price fixing – especially if all the health insurance providers act in this manner? 
Since I was promised that the price through Medco would be lower, I cancelled the order with my pharmacy and placed the order with Medco.  I contacted Medco by phone and was informed that I could not find out the price of the medications until they received the prescriptions from my physician.  I would then be able to see the invoice on-line.  A day or two later I went to their website.   
There was a screen telling me that I could not access my account until I provided updated payment (credit card) information.  I did so and to my shock discovered that while the 90-day supply of Losartan was only going to cost $79.84 (the 30-day supply at my pharmacy would have been $68.28 so this amounted to a savings of $125.00), the Simvastatin was now going to cost me $115.24 (the 30-day supply at my pharmacy would have cost me $7.14 so I was now paying $93.82 more than if I had purchased the same medication at my pharmacy over a three-month period). 
I immediately contacted customer service at Medco to cancel the order for the Simvastatin.  I was told that the drugs had been shipped and there was nothing that they could do about it.  I needed to contact EmblemHealth. 
The second issue, therefore, is one of interstate commerce.  The physical pharmacy from where the drugs were shipped is in Delaware.  I live in New Jersey.  Medco did not offer me the opportunity to view the price of the medications before I purchased them.  Even though literally only a few minutes had passed between my entering my credit card information and my calling them, they could do nothing about it. 
The strange thing is that the notice that appeared on the Medco website when I logged on informing me that they needed updated payment information said that the medication would not be shipped until I provided the information.  Yet the Medco representative said that it had already been shipped. 
Should not companies involved with interstate commerce be required to provide pricing information prior to a sale being finalized?  In truth, I have purchased countless items on-line.   
In all cases, before submitting the order, I have always been given the opportunity to see the final price and to cancel the order.  This, as stated, was not the case with Medco.  Why should this common practice and courtesy of Internet-based business not apply to a pharmacy? 
On May 13 I called EmblemHealth and spoke with a representative named Suzie.  She admitted that the price for the Simvastatin had to be an error.  May 13 was a Friday.  She told me that someone would contact me over the weekend, Monday at the latest. 
On Tuesday the 17th, I called EmblemHealth and spoke with Stephanie.  When I told her the story, she transferred me to Suzie who again told me about the above mentioned April 17 letter.  She said I could get the Simvastatin at the lower rate from my own pharmacy.   
I reiterated to her that while that was all fine and good in the future, I had been told that using Medco would save me money on both prescriptions and, as far as the Simvastatin was concerned, I was out $93.82. 
I explained to Suzie the seriousness of the situation and that I did not think it was fair that she be the public face, so to speak, of this issue.  I asked to speak with a supervisor.  She put me on hold and came back and said that her supervisor was at lunch and that he would call me back.  I gave her my office number and asked for the supervisor’s name.  She said, “Raymond.”  I asked what his last name was.  She said she could not tell me.  I told her, very politely, that that was not a good answer.   
I explained that this was going to become a big deal and that it would not be a smart move to refuse to give me the supervisor’s full name.  She called me back and said that the best she could do was to give me his initial, “F.”  She reiterated that he would be calling me. 
That was at approximately 3 PM on the 17th.  As I had not heard from him I called at 2 PM on the 18th.  I spoke with Bea who told me she could not locate either Suzie or Raymond but would try to connect me with a supervisor.  
Prior to that she mentioned that the price issue may have had something to do with my deductable but, as she confirmed, Pathmark had charged me a deductable, and she dropped the issue. 
I was transferred to Phoenix.  She told me that when Pathmark processed the claims the reimbursement rate to them was incorrect.  She said that she understood my concerns and would “escalate” this to a supervisor who would be in touch with me within 2 business days, meaning by the end of business today, Friday the 20th.  No one has contacted me. 
I am the host of a radio program, Bruce Hurwitz Presents, on BlogTalkRadio Network.  Since January of this year, I have had over 2,000 listeners.  I have scheduled a broadcast for Thursday, June 16 at 11:30 AM (Eastern Time) to discuss this issue.  
 Needless to say, I will be advertising this episode to my network which includes over 19,000 professionals.  I will also be contacting the reporters in whose articles I have appeared over the past year (some 150 in total – you can see the full list on the Media Center page of my website, asking them to promote the show as well.  It will be a live half-hour broadcast.   
I would like to invite you or your representative to participate.  Both EmblemHealth and Medco are receiving copies of this letter and their representatives are also invited to participate.  Please confirm your participation at least one day in advance of the broadcast.  If you will be represented by a staff member, I will need their name and the phone number from where they will be calling so that I can identify them and assure their participation.   
 At the conclusion of this letter is the promotional announcement for the show.  (Please note that the broadcast itself will remain available in perpetuity and you will be able to use it, as you see fit, at any time.) 
Thank you in advance for your attention to this matter.  Anything you can do to get me a refund or, even more importantly, to assure that this does not happen to anyone else, will be much appreciated. 
Once again, thank you for in advance for your assistance and, hopefully, for your participation in the broadcast. 
Bruce A. Hurwitz, Ph.D.
Are EmblemHealth & Medco Fixing Prices & Violating the Law?
This show is going to be personal.  I take two medications.  Both are generic.  The price of one just went up 73% while the price of the other rose 350%!  When my health insurance company informed me that I could get lower prices if I used their pharmacy, well… it did not turn out that way.
This show will explored two main issues:  First, can a health insurance company charge their own pharmacy one price for drugs and other pharmacies another price?  Isn’t that a violation of anti-trust laws?
Second, when I placed the order for the medications, I could not find out the prices until after they had received my payment information and the invoice had been processed.  That’s when I really got sticker shock!  This leads to the question of Internet-based companies charging individuals for products without first revealing the prices.  Isn’t this an issue of the regulation of interstate commerce?  And why, when no one else does it, can a pharmacy?
Listen into Bruce Hurwitz, PH.D fight with big phama on Blog Talk Radio at this link.
Author Bio
Bruce A. Hurwitz, Ph.D., has been an executive recruiter since 2003.  He has successfully placed scores of professionals in senior executive, managerial and administrative positions in both the non-profit and corporate sectors.  Prior to becoming a recruiter, he had some 15 years non-profit experience as an executive, fundraiser, marketer and communications professional. A sought-after speaker, Dr. Hurwitz was a previous guest expert on the Reach Out Job Search Podcast on the Blog Talk Radio network October 28, 2010.

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