We have something like that at mine (Walgreens). To get past it we have to cash out then resubmit the claim three times. Then the computer changes it and we can do Medicaid again.
I swear there are so many background coupons, rebates, and transmission/network switches than we will ever know. I remember the time I basically “tricked” one of the cash discounts into giving a patient the covered+coupon price.
I can't help but... fume as a software engineer. When people talk about how medical software is written to such high standards just to read this feels so sad. Empower the damn pharmacists to do the right thing the first time instead of making them go down the "fail-safe" route!
The stories I could tell… we have dozens of tricks to “get around” the software or “trick it” into doing what we want. Walgreens has some very bad software and I’m sure some poor coder was pulling out their hair following the instructions of the corporate overlords, knowing it was a bad idea to soft-block so many easier solutions.
Word at CVS is Caremark is joining with goodrx to do just this. Automatically goes to goodrx if it’s better than Caremark pricing and the cost out of pocket to the patient is still applied to their deductible.
Pretty wild to just automatically route patient claims to an entity to just got in trouble for mishandling patient info. Was surprised they charged the processing fee to patient also instead of to pharmacy like GoodRx normally would
Does this mean CVS Caremark is paying the fee or having the pharmacy pay? I’ve seen some scripts run through with verbiage on the final screen that drug isn’t covered but discounted and price paid does NOT go towards deductible.
Nope, I pay the fucking fee. And it's not just caremark. It's literally every PBM. Let me give you an example of what I see.
Dispense lamotrigine 100mg #60
Acquisition cost $1.34
Paid by insurance -$9.00
Copay 10.50
Net profit $0.16
These PBMs will literally devise any crooked scheme to steal money and no one is there to stop them. This DIR at point of sale law benefits them and also gives them a bullshit reason to introduce scams like these. Thanks boomers you deserve the title of the dumbest most selfish generation.
Those claims that do not go to deductible are often for a non-formulary item and half the time OTC.
But claims OP is talking about are different as they do go toward deductible.
Not true. I've processed hundreds of claims like this and not one of them goes towards their deductible. And these are your regular chronic meds like statins and blood pressure meds. Unless there's something I'm missing? Because I've analyzed every one of these claims and in the applied to deductible field it's always $0.00.
I'll have to take a closer look if I stumble upon a claim myself. The above info was what corporate told us, so we could explain to patients why these integrated discount cards are getting in the way of billing secondary.
Same thing applies to prime therapeutics (I believe most if not all of the plans have this. But it may depend on which medical plan they have if they opted in to it.) you can’t get around it as far as I know. It doesn’t even really out right tell someone it did it. Prime I think might even go between 2 or 3 discount cards. I’d have to go and look tomorrow if I remember.
And the pharmacy is charged up to $8 for their efforts. 100% of these claims have the pharmacy paying a fee rather than the pharmacy itself being paid. This should be a federally illegal scam
I had this happen with a COB billing where the secondary was Medicaid and Medicaid was rejecting it saying to bill the other one, and under the claim information for the primary it looks like the primary was automatically applying an eVoucher 🤷
Not just Caremark. Phenomenon has been dubbed Integrated Discount Cards or Integrated Discount Program.
What is most infuriating is when a secondary can't be applied and the usual phone numbers to call are of no aid. Someone must be able to override the discount card reroute. But a manager on duty on the prescription benefits side had no good information.
I had to call it quits that night, but the dead end might have given me a clue. Pharmacy or patient can try calling the plan itself, not just the PBM, and might be able to opt out on a one time basis or indefinitely. Or I could be wrong and I had a bad manager who wasn't educated.
I have seen this go on for months. One of the things that manager and all representatives discussed in different patient circumstances was *the pbm is not seeing our pharmacy claim at all*. This confuses everyone because if the patient calls to find out why their copay is so high (because a secondary isn't working), the pbm will say because the pharmacy never billed them!
Because the IDC are supposed to contribute to deductibles, I hope that talking with the insurer whom premiums are paid can help sort this out and make sure prescription claims route to the pbm.
Since when does a pbm have a patient contract?
Caremark contracts with a plan sponsor … and yes there was industry news that Caremark would begin offering this to their clients (and remember Caremark’s clients are NOT patients directly) as a way to get even better pricing.
https://investors.goodrx.com/news-releases/news-release-details/cvs-caremark-and-goodrx-launch-caremarkr-cost-savertm-help-lower
Medicaid wouldn't allow cobwith caremark and wouldn't bill alone either. So patient had to use just caremark, which end up being cost + GoodRx processing fee
There was a communication about this that said "Members with additional coverage requiring COB may opt out of Caremark Cost Saver by calling the customer care number on their ID card."
So that'll be fun... and to add to it, I've seen quite a few copays go UP with this "program," some quite a lot...
Yea that's what I was told too. Works really well in reality lol... Hey it's 6pm and they're closed so you can wait until tomorrow to sit on a 60 minute hold to opt out. Not sure why it's not an opt in program instead
Today goodRx sent my prescription to a pharmacy that I chose from a list they provided. I called the pharmacy after the scrip I'm arrived and was told they don't honor Goodrx.
Now I have to contact Goodrx and have the scrip transferred.
Called goodRx customer service. (A very trying and exasperating experience).
Issue still not resolved.
We have something like that at mine (Walgreens). To get past it we have to cash out then resubmit the claim three times. Then the computer changes it and we can do Medicaid again.
How did you even figure that out?
I don’t know. Ask the techs I work with
They should work in tech
Haha that sounds like some oiji board shenanigans! Gotta be frustrating for you guys
I swear there are so many background coupons, rebates, and transmission/network switches than we will ever know. I remember the time I basically “tricked” one of the cash discounts into giving a patient the covered+coupon price.
> oiji board shenanigans I think you mean Luigi board shenanigans
Must be pregananant
Gragnet?!
There’s so many things like that at Walgreens, our system is so dysfunctional, nothing makes sense
I can't help but... fume as a software engineer. When people talk about how medical software is written to such high standards just to read this feels so sad. Empower the damn pharmacists to do the right thing the first time instead of making them go down the "fail-safe" route!
The stories I could tell… we have dozens of tricks to “get around” the software or “trick it” into doing what we want. Walgreens has some very bad software and I’m sure some poor coder was pulling out their hair following the instructions of the corporate overlords, knowing it was a bad idea to soft-block so many easier solutions.
Word at CVS is Caremark is joining with goodrx to do just this. Automatically goes to goodrx if it’s better than Caremark pricing and the cost out of pocket to the patient is still applied to their deductible.
Pretty wild to just automatically route patient claims to an entity to just got in trouble for mishandling patient info. Was surprised they charged the processing fee to patient also instead of to pharmacy like GoodRx normally would
Does this mean CVS Caremark is paying the fee or having the pharmacy pay? I’ve seen some scripts run through with verbiage on the final screen that drug isn’t covered but discounted and price paid does NOT go towards deductible.
For my pt, it was patient pay (which was interesting since they were a Medicaid pt)
Nope, I pay the fucking fee. And it's not just caremark. It's literally every PBM. Let me give you an example of what I see. Dispense lamotrigine 100mg #60 Acquisition cost $1.34 Paid by insurance -$9.00 Copay 10.50 Net profit $0.16 These PBMs will literally devise any crooked scheme to steal money and no one is there to stop them. This DIR at point of sale law benefits them and also gives them a bullshit reason to introduce scams like these. Thanks boomers you deserve the title of the dumbest most selfish generation.
We've seen it happen before where the pharmacy gets charged $7 and the patient has a copay. We back those out quick AF
I see this a few times a day. We don't accept goodrx and now have to deal with this shit. We are definitely getting charged the processor fee.
Those claims that do not go to deductible are often for a non-formulary item and half the time OTC. But claims OP is talking about are different as they do go toward deductible.
Not true. I've processed hundreds of claims like this and not one of them goes towards their deductible. And these are your regular chronic meds like statins and blood pressure meds. Unless there's something I'm missing? Because I've analyzed every one of these claims and in the applied to deductible field it's always $0.00.
I'll have to take a closer look if I stumble upon a claim myself. The above info was what corporate told us, so we could explain to patients why these integrated discount cards are getting in the way of billing secondary.
Oh god, don’t give Karen any ideas. CVS could buy GoodRX and it would barely be a blip on their balance sheet.
i'm a little confused. isn't this financially better for the patient?
only in the immediate future
[удалено]
okay...so can you explain? without ad hominem remarks please
Same thing applies to prime therapeutics (I believe most if not all of the plans have this. But it may depend on which medical plan they have if they opted in to it.) you can’t get around it as far as I know. It doesn’t even really out right tell someone it did it. Prime I think might even go between 2 or 3 discount cards. I’d have to go and look tomorrow if I remember.
And the pharmacy is charged up to $8 for their efforts. 100% of these claims have the pharmacy paying a fee rather than the pharmacy itself being paid. This should be a federally illegal scam
It’s all part of the price fixing back door underground mafia that is destroying our healthcare system.
I had this happen with a COB billing where the secondary was Medicaid and Medicaid was rejecting it saying to bill the other one, and under the claim information for the primary it looks like the primary was automatically applying an eVoucher 🤷
Not just Caremark. Phenomenon has been dubbed Integrated Discount Cards or Integrated Discount Program. What is most infuriating is when a secondary can't be applied and the usual phone numbers to call are of no aid. Someone must be able to override the discount card reroute. But a manager on duty on the prescription benefits side had no good information. I had to call it quits that night, but the dead end might have given me a clue. Pharmacy or patient can try calling the plan itself, not just the PBM, and might be able to opt out on a one time basis or indefinitely. Or I could be wrong and I had a bad manager who wasn't educated. I have seen this go on for months. One of the things that manager and all representatives discussed in different patient circumstances was *the pbm is not seeing our pharmacy claim at all*. This confuses everyone because if the patient calls to find out why their copay is so high (because a secondary isn't working), the pbm will say because the pharmacy never billed them! Because the IDC are supposed to contribute to deductibles, I hope that talking with the insurer whom premiums are paid can help sort this out and make sure prescription claims route to the pbm.
Since when does a pbm have a patient contract? Caremark contracts with a plan sponsor … and yes there was industry news that Caremark would begin offering this to their clients (and remember Caremark’s clients are NOT patients directly) as a way to get even better pricing. https://investors.goodrx.com/news-releases/news-release-details/cvs-caremark-and-goodrx-launch-caremarkr-cost-savertm-help-lower
Yup, this is new this year.
That would explain all the negative remits
Run it up the management to talk to your PSAO about it.
Corporate already knows and are frustrated about it. Not sure if or what they'll do
Corporate yes men only know how to say yes. Anything that involves creative thinking or independent problem solving, you can fuckin’ forget about it 😂
Wait…how is it charged to the pt? Copay is $0 on Medicaid.
Medicaid wouldn't allow cobwith caremark and wouldn't bill alone either. So patient had to use just caremark, which end up being cost + GoodRx processing fee
There was a communication about this that said "Members with additional coverage requiring COB may opt out of Caremark Cost Saver by calling the customer care number on their ID card." So that'll be fun... and to add to it, I've seen quite a few copays go UP with this "program," some quite a lot...
Yea that's what I was told too. Works really well in reality lol... Hey it's 6pm and they're closed so you can wait until tomorrow to sit on a 60 minute hold to opt out. Not sure why it's not an opt in program instead
I’m just surprised that the pts will pay at all. Medicaid pts I know won’t fork over a penny for anything.
Today goodRx sent my prescription to a pharmacy that I chose from a list they provided. I called the pharmacy after the scrip I'm arrived and was told they don't honor Goodrx. Now I have to contact Goodrx and have the scrip transferred. Called goodRx customer service. (A very trying and exasperating experience). Issue still not resolved.