Friday, May 24, 2019
Hawai'i Free Press

Current Articles | Archives

Friday, May 13, 2011
HMSA: Mail-order Pharmaceutical plan losing support of Hawaii Physicians
By Andrew Walden @ 5:45 PM :: 7457 Views :: Energy, Environment

by Andrew Walden

Hawaii is leading the nation in implementation of the Affordable Healthcare Act but parts of the program are already losing the support of doctors. 

In a letter of apology to Hawaii physicians dated May, 2011, John T. Berthiaume, HMSA’s Vice-President of Care Management admits doctors are experiencing “frustration” and “extra work” as HMSA rolls out cost controls and a “closed formulary” medical rationing program.

Why adopt a new system?  The letter makes HMSA’s reasoning clear:  “The new formulary is expected to save $4.5 million annually in drug costs.”

The “closed formulary” is a list of the prescription drugs covered by HMSA. Mail-order pharmacy Medco is HMSA’s formulary provider.

But is it patients who are paying the price for HMSA’s profits.  Berthiaume explains:

As part of its cost management, Medco places quantity limits on certain drugs to ensure the amount dispensed is consistent with prescribing guidelines. Please be aware that some low-cost generic drugs, such as prednisone, require prior authorization for medical diagnoses so that HMSA can properly direct coverage to either the patient’s Medicare part B or Part D benefits.

Berthiaume describes the “unanticipated impacts” of the transition to Medco formulary:

Physicians did not receive correct advance notice about changes to the formulary and/or coverage rules, such as new quantity limits for certain drugs; were not given timely information on prescribing options; and had unsatisfactory experiences when contacting Medco. Physicians said the new coverage review procedures were time-consuming. They reported servicing problems, such as long wait times on the phone and inconsistent answers, in dealing with Medco representatives. Finally, of 5,000 letters mailed to 1,600 patients and their 500 doctors regarding quantity limits, most were generated mistakenly due to a Medco system programming error….

It is not clear why HMSA could not “anticipate” such impacts.  Millions of Americans have been protesting against Obamacare for over a year now.  The bureaucratic interference, bungling, and rationing described in the HMSA letter reads like a caricature of what these “TEA Party” protesters have warned of. 

A Hilo doctor who received the letter would speak only anonymously due to fear of HMSA retaliation.  The doctor said:

“This is the first time I have ever seen an apology from HMSA for anything.  There must have been a huge outcry or possible legal implications.  The formulary changes weekly, so a patient on one prescription suddenly can't get it renewed.”

Medco’s website paints a different picture:

“At Medco, we take the view that we are our customers' champions - and we are committed to providing you with smarter solutions that give you more value in return for every dollar you spend.”

But Medco’s “customer” is HMSA—and Medco’s job is to save it’s customer $4.5M.  Patients obtaining their prescriptions are Medco’s products—and it shows.

Medco urges potential customers—insurance companies—“To learn more about how we can make pharmacy work for you, contact our Government specialists today at Medco New Business Inquiries.”  And then just in case patients don’t get the hint: “Note: Please do not use this e-mail address for member or benefit inquiries.”

Consumer-oriented websites such as ConsumerAffairs.com and HealingWell.com have dozens of Medco testimonials going back to 2005—nearly all negative.  A typical one reads:

The most recent complaint is with shortages and broken pills. I always count my pills because so many times I have been shorted. Ironically (or not) it happened most often with class 3 - darvocet.

I'd report the shortages via messaging on their web site and I'd sometimes get no response. Sometimes I'd write again or sometimes I'd give up. It happened so often I pressed it sometimes.

With the darvocet it did happen too often they must have an in-house problem with stealing one pill here and there of narcotic pain pills, so I kept insisting they replace the 1 or 2 pills they shorted my order.

In spite of Medco’s lengthy record, HMSA tells physicians their complaints “have been relayed” and additional staff training “will be provided”.  “Efforts to simplify…are underway.”  Physicians are promised “more timely updates” every time the closed formulary is changed and the telemarketers in Medco’s call center will even deign to establish “coverage during Hawaii hours of operation” and “streamline the handling of phone calls.”

---30---

FULL TEXT: HMSA Letter of Apology

Links

TEXT "follow HawaiiFreePress" to 40404

Register to Vote

2aHawaii

808 Silent Majority

808 State Update AM940

ABCDEFG Blog

ACA Signups Hawaii

ACCE

Affordable Hawaii Coalition

ALEC

Alliance Defending Freedom

Aloha Conservative Alliance

Aloha Life Advocates

Aloha Pregnancy Care Center

American Council of Trustees and Alumni

American Mothers of Hawaii

AMVETS-Hawaii

AntiPlanner

Antonio Gramsci Reading List

A Place for Women in Waipio

Audit The Rail

Ballotpedia Hawaii

Better Hawaii 

Blaisdell Memorial Project

Broken Trust

CAFR Hawaii

Castaway Conservative

Children's Alliance Hawaii

Children's Rights Institute

Christian Homeschoolers of Hawaii

Citizens for Recall

Cliff Slater's Second Opinion

Coffee Break

Conservative Forum for Hawaii

CSIS Pacific Forum

DAR Hawaii

DeedySupport.com

DVids Hawaii

E Hana Kakou Kelii Akina

E Māua Ola i Moku o Keawe

Farmers For Choice Hawaii

FIRE

Fix Oahu!

Follow the Money Hawaii

Frank in Hawaii

Front Page Magazine

Frontline: The Fixers

Genetic Literacy Project

Get Off Your Butts!

God, Freedom, America

Grassroot Institute

Habele.org

Hawaii Aganst Assisted Suicide

Hawaii Aquarium Fish Report

Hawaii Aviation Preservation Society

Hawaii Catholic TV

Hawaii Christian Coalition

Hawaii Cigar Association

Hawaii Coalition Against Legalized Gambling

Hawaii ConCon Info

Hawaii Credit Union Watch

Hawaii Crime Victims' Rights

Hawaii Crop Improvement Association

Hawaii Debt Clock

Hawaii Defending Marriage

Hawaii Defense Foundation

Hawaii Families for Educational Choice

Hawaii Family Advocates

Hawaii Family Forum

Hawaii Farmers and Ranchers United

Hawaii Farmer's Daughter

Hawaii Federalist Society

Hawaii Federation of Republican Women

Hawaii Firearm Community

Hawaii Fishermen's Alliance

Hawaii Future Project

Hawaii Gathering of Eagles

Hawaii History Blog

Hawaii Homeschool Association

Hawaii Jihadi Trial

Hawaii March for Life

Hawaii Meth Project

Hawaii's Partnership for Appropriate & Compassionate Care

Hawaii Public Charter School Network

Hawaii Rifle Association

Hawaii Right to Life -- Big Island

Hawaii Right to Life -- Oahu

Hawaii Shield Law Coalition

Hawaii Shippers Council

Hawaii Smokers Alliance

Hawaii State Data Lab

Hawaii Together

Heritage Foundation

HI Coalition Against Legalized Gambling

HIEC.Coop 

HiFiCo

Hiram Fong Papers

Homeschool Legal Defense Hawaii

Honolulu Homeless Crisis

Honolulu Navy League

Honolulu Traffic

Horns of Jericho Blog

House Minority Blog

House Republican Caucus YouTube

HPACC

Hump Day Report

I Vote Hawaii

If Hawaii News

Inouye-Kwock, NYT 1992

Inside the Nature Conservancy

Inverse Condemnation

Investigative Project on Terrorism

Iowa Meets Maui

Jackson v Abercrombie

Jihad Watch

Judgepedia Hawaii

July 4 in Hawaii

Kahle v New Hope

Kakaako Cares

Kau TEA Party

Kauai Co GOP

Keep Hawaii's Heroes

KeyWiki

Land and Power in Hawaii

Legislative Committee Analysis Tool

Lessons in Firearm Education

Lingle Years

Malulani Foundation

Managed Care Matters -- Hawaii

Malama Pregnancy Center of Maui

Mauna Kea Recreational Users Group

MentalIllnessPolicy.org

Middle East Forum--The Legal Project

Mililani Conservatives for Change

Military Home Educators' Network Oahu

Missile Defense Advocacy

MIS Veterans Hawaii

Muslim Brotherhood in America

NAMI Hawaii

NARTH

Natatorium.org

National Christian Foundation Hawaii

National Parents Org Hawaii

National Wind Watch

New Zeal

NFIB Hawaii News

No GMO Means No Aloha

Northwest Economic Policy Seminar

Not Dead Yet, Hawaii

Now What I Really Think

NRA-ILA Hawaii

Oahu Alternative Transport

ObamaCare Abortion Hawaii

OHA Lies

Opt Out Today

OurFutureHawaii.com

Pacific Aviation Museum

Patients Rights Council Hawaii

PEACE Hawaii

People vs Machine

Pritchett Cartoons 

Pro-GMO Hawaii

P.U.E.O.

RailRipoff.com

Rental by Owner Awareness Assn

Republican Party -- Hawaii State

Research Institute for Hawaii USA

Rick Hamada Show

RJ Rummel

Robotics Organizing Committee

Salvage The Rail

Save the Plastic Bag

School Choice in Hawaii

SenatorFong.com

SIFE Remington

SIFE W. Oahu 

Sink the Jones Act

Smart About Marijuana--Hawaii

St Marianne Cope

State Budget Solutions Hawaii

State Policy Network

Statehood for Guam

Tax Foundation of Hawaii

The Harriet Tubman Agenda

The Long War Journal

The Real Hanabusa

Time Out Honolulu

Truth About Trade & Technology - Hawaii

UCC Truths

Union Members Know Your Rights

US Tax Foundation Hawaii Info

Valor in the Pacific

VAREP Honolulu

Waagey.org

West Maui Taxpayers Association

What Natalie Thinks

Whole Life Hawaii

Yes2TMT