Still food or drugs Date Rated: 11/8/2016 11:04:42 PM
I have had Express Scripts twice as a Medicare Part D choice. My experiences have been mixed. Like most of the Medicare D plans, they can and do change their formulary throughout the year, and drugs that were on the generic tier 1 formulary are increasingly showing up in higher tiers. The copay is quite expensive for most drugs, even some of the generics, and I can sometimes get my medications for less with a coupon from GoodRx or the regular price at the pharmacy, if I pay out of pocket in both instances. The drawback to this is that it doesn't count toward getting into and especially out of the infamous "doughnut hole". The copay for a biologic such as Enbrel is $1200. per month, for example. Given that it is $4000. out of pocket, that is a savings IF you can afford the drug in the first place. For those of us living on Social Security, that is not affordable. Many common generic drugs in use for decades for my conditions have required preauthorization, which Express Scripts is slow to provide, thus saving them as many as 3 months of not having to provide these medications. I believe this company takes advantage of the insurance mantra "Deny, delay, don't pay." Both times I have been on the plan I have gone without prescribed medications for months due to their delays in approving preauthorizations. Their excuse that the doctor hasn't filled out the forms doesn't wash, since I have seen copies of the forms and the mailing dates. The mail order pharmacy is non-existent, although they claim to have one. Their mail order service's incompetence, higher pricing and lack of fulfillment of prescriptions means that in my opinion there is no benefit to their mail order pharmacy.
The reason I have signed up with them twice is that: their customer service is quite good if you are willing to pester them; their availability of medications was good until this year; and their ratings have been consistently higher than any other plan in my area. In 2017, however, even fewer of my medications are covered and their placement of most of my drugs in higher tiers means that I probably won't renew with them. The only thing that might mean I renew is that the other plans available in my area are even worse.