Mail-Order Prescriptions
[Published by The Oak Ridger, January 12, 2012]
Is anybody besides me upset at ORNL Benefits’ decision to make medical plan members use a mail-order pharmacy for their “maintenance” medications?
Last year ORNL split its medical plan off from the plan administered by Y-12. ORNL Benefits sent members a booklet informing them about an open enrollment period from 10/10/11 – 10/28/11 (which arrived in my mail on 10/11/11). It stated that ORNL Benefits’ health care costs “are 30% higher than the national average” (no explanation as to why). It said that “ORNL, not CIGNA, pays for the health care expenses of our employees …. [who] pay a portion of that cost through your premiums and copayments”. This is confusing, as it seems to imply that ORNL is paying directly for each medical service rather than a set amount per person to the insurance company as its portion of the premium.
The booklet also said that Benefits’ program “encourages” members to use a designated mail-order pharmacy (MOP) for maintenance drugs. As of 1/1/12 a member can have three “fills” of a drug “at retail” (i.e., locally) but then “has to” move to mail order. If the member continues to use a local pharmacy for refills, then Benefits will not pay anything for the drug — not even the amount that it would have paid the MOP.
Members were later sent a letter (which I received on 12/17/11) reiterating the de facto requirement that members use the MOP and stating that this will lower the cost of prescriptions, resulting in “passing the savings on to you …. through lower premiums”. But premiums are being raised for 2012.
A local pharmacy rep confirmed that local Oak Ridge pharmacies will lose a lot of business because so many older people in Oak Ridge are on maintenance meds. So much for buying local.
My doctor said that even now, without having everybody on the mail-order plan, it often happens that a patient is caught short of pills and will need one prescription for the MOP and another for seven days for the local pharmacy (i.e., until the mail-order drugs arrive). The time his practice spends on processing the extra prescriptions is not reimbursed.
An ORNL Benefits Service Center rep confirmed the booklet statements, except that he said that what ORNL pays is a share of the premium, not the direct costs. He agreed that members are “over a barrel” if they don’t use the MOP; that the same premium would be collected whether the MOP was used or not; and that it “was too bad” about local pharmacies losing business. He also agreed that a higher premium coupled with having to use the MOP means that we will be paying more for less service.
I suppose that ORNL Benefits is up against it, financially speaking. But still, not giving members the option of choosing to pay the difference themselves between what the MOP costs the plan and the full retail charge seems like a severe service cut, especially when the member is thus deprived of face-to-face consultation with a pharmacist and has to be home to receive medication that shouldn’t experience extremes of temperature in the mailbox or on the porch. (And are those MOP pharmacists vetted in any way by the State of Tennessee?) Not giving the members their choice of several MOPs is also a reduction in service. (Does ORNL Benefits have some sort of volume agreement with the designated MOP, so that members must be herded en masse into the program?) We know we have a third-rate pension plan. Now, it seems, we are to have a third-rate medical plan.
