Weird Prescription Practice

[LMichaels]

So, a couple days ago I get a text from Costco Pharmacy. Telling me my script is ready. OK that's good but there is some weird chemical name I can't recognize let alone pronounce. So, I figure it's a mistake. Meanwhile a couple more become ready so I called them today before going to inquire.
Spoke to them, and here is the explanation. I take a drug called Farxiga. Used to help my damaged kidneys (thanks to a previous doc not realizing metformin can do serious kidney damage back when I was first diagnosed as Type 2 diabetic. When my kidney failure became even worse, she was so perplexed she sent me to a Nephrologist. First thing he said, "you're taking Metformin didn't they warn you it could send you into kidney failure?" I'm like Holy S^&T! So he in turn then sends me to an endocrinologist who right away gets me onto Farxiga. Apparently because it helps with A1C but also can help "heal" and control kidney damage.
So I've been on it now a number of years. It's expensive but the company who makes it has a program to help offset the cost with special coupons (as long as you're not on Medicare). So that is what I've been doing and paying $25-$35 per month
Turns out a generic for it just came available, and BCBS says if the Dr is not specifying brand name give the generic. But the generic was $150!!!! WITH insurance! So, I tell them "no give me the brand name" Boom back down to $25. Go figure

 

[JKalchik]

Nope. Sounds like standard practice. And due in major part to the 3 major mail order pharmacies (CVS Caremark, Express Scripts, and OptumRX,) all running their "pharmacy benefits manager" scams. Make no mistake, the PBM programs are categorically NOT to control your costs, but your insurance provider. Supposedly, those 3 pharmacies wrote something like 80% of the last year's prescriptions. The FTC has released a report recently detailing their activities and the 3 companies have apparently filed a lawsuit claiming the report is filled with "lies and innuendo." Smells like modus operandi to me.

I'm pretty sure that I've got internal entries in my current mail order pharmacy's profile, and probably not flattering, but more like "don't mess with him!" I've already called them HARD on shenanigans twice now, and both times, they came out losing.

Edit: I should add that my primary gripe from above is that pharmacies categorically should NOT be allowed to run captive pharmacy benefits manager programs. Clients should be a customer of one or the other, but absolutely not both. I don't see that the PBMs have either my interest, or the employers, but the pharmacies own self-interests in keeping their profits up.

 

[Chris Allingham]

Used to help my damaged kidneys (thanks to a previous doc not realizing metformin can do serious kidney damage back when I was first diagnosed as Type 2 diabetic.

I know you've mentioned this before, and I'm not questioning your personal experience, but it's important for readers to consult with their doctor about metformin. It's the most commonly prescribed Type 2 diabetes drug in the world for a reason.

 

[LMichaels]

I know you've mentioned this before, and I'm not questioning your personal experience, but it's important for readers to consult with their doctor about metformin. It's the most commonly prescribed Type 2 diabetes drug in the world for a reason.

Yes, my doc told me the same but he then tempered it with it's also one of the if not the oldest as well. So don't misunderstand me. I'm NOT telling anyone what or how to medicate with. ONLY what happened to myself (and a number of people I know personally) with it, and what both the Nephrologist told me as well as the Endocrinologist. Both told me to a fault, that while it's effective and generally considered "safe" the "safe" terminology is a relative thing. Both also said when they have patients using it they recommend bi-annual blood work to check kidney function.
Again, not a Dr, (though I do play one on TV ) Simply relating my personal experiences, and how I ended up needing this quite expensive drug that is all. Definitely NOT making medical advice or recommendations
As always YMMV

 

[JKalchik]

An educated patient is a good patient.... or so my GP/PCP tells me. We've had several short conversations (along with the clinic nurses,) about being able to have an informed exchange. The conf call I had with her a month ago when I was in the initial stages of COVID is a perfect example: my symptoms are relatively mild, and being apparently treated well with OTC meds, so the side effects of the anti-viral meds would seem to be worse than what I'm experiencing. I'll keep on keepin' on. For the record, I am on metformin, and do have full blood panels annually, especially liver and kidney functions. Knock wood, all is well, and the nursing staff at the clinic practically dance around me, telling me they will all of their patients were so diligent.

Back to the original discussion..... short story is that it's not personal, it's all about the money. IMO, PBMs want to increase pharmacy profit margins, as that's my observation. I've caught mine claiming product shortages, and I've publicly called them out on it, by having conversations with multiple pharmacies and in one case, even the manufacturer. Everybody except my pharmacy said yeah, we have no problem getting it, or supplying it, yet my pharmacy tried the hard line that "it's just not available."