Express Scripts - A mail order company with conflicts of interest

 Conflict of Interest - 

• a situation in which the concerns or aims of two different parties are incompatible.
• a situation in which a person is in a position to derive personal benefit from actions or decisions made in their official capacity.

 Express Scripts (E.S.) is a mail-order prescription supplier and a prescription insurance company.  A conflict of interest arises when your local pharmacy wants to provide a temporary fill for a prescription, and Express Scripts locks out the pharmacy from filling that prescription. "Too Soon to Order"

This is blatantly false because Express Scripts has not yet filled the prescription, shipped the prescription, delivered the drug, and at the very least, "you" have not received the medication.  How can it be too soon for the local pharmacy to fill if you have not received the medication?

The simple answer is it is not too soon.  In fact, local pharmacies and patients always deal with this.  According to one local pharmacy, when asked if this is a problem with all mail-order companies, the response was, "No, this is mainly a problem with Express Scripts." 

Express Scripts knows this is a problem because every time it happens, the local pharmacy can call Express Scripts, explain the circumstance and obtain an exception to fill the prescription.  But this is wrong in too many ways.  First, it is unnecessary and a waste of time for the local pharmacy.  Express Scripts refers to this as an "exception," which it is not; it's a regular occurrence.  All that is required in this day and age of automation is for your doctor to receive a request from the patient indicating that their supply has run out.  (We won't get into solving this problem right now, and we'll save it for another blog.) The doctor requests a local pharmacy for an emergency supply and the prescription with refills from the mail-order company.  Express Scripts fulfillment is automated after the request is made, except for the local pharmacy fulfilling this request. It fills the prescription automatically 'before' the pharmacy can supply me with the emergency supply... and this makes them jump through hoops before they get authorized to fill it.  What a time waster, sarcastically, "Thank you, Express Scripts."

2021-05-18 Update:
A new system was rolled out by Express Scripts; it takes care of 'some' of the issues mentioned above; however, there are others.  Of course, in the switch over... I picture some IT guy's head rolling... from Hero to Zero.  It drained our FSA before it was caught, and suddenly we have no money to pay for prescriptions.  Apparently, the cancer medication is expensive; fortunately for me, it's underwritten... unfortunately getting the money from the FSA was more accessible, if wrong, and drained the account.  This was rectified immediately.. and by that, I mean within a month or so.  Sheesh.  At least it's fixed now.

So, one more issue to throw at everyone.  Having your mail-order drug supplier also be the insurer is a bad idea... One gigantic conflict of interest.  The more orders they withhold from the local provider creating a precidence conflict prohibiting the patient from receiving a temporary supply from a local provider in a timely manner... the more money they save on medication they didn't pay for, as the insurer, when you needed it.  This conflict not only risks the patient's health, it served to prohibit a local supplier earning money. Yeah... it's really like that sometimes. By wasting your time, and the local provider's time resolving the problem, they make money.

Definition: "in a timely manner." By this, I mean to be received in time to meet your medical needs. Causing, for example, a missing medically necessary medication. One that is not received in time to maintain well-being and health, or threatens possible death due to an inability to obtain needed medication.