Express Scripts

Normally, I’m pretty easy going. It really takes a lot to really get me mad. Express Scripts, Anthem's pharmacy benefit manager, has succeeded royally.

Background: Untreated, I have fairly high cholesterol levels. Over a couple of years my doctor and I have worked out a regimen consisting of 10mg of Zetia and 40mg of Lipitor. Lipitor is a statin, a HMG-CoA reductase inhibitor that blocks the formation of cholesterol in the body. Zetia inhibits the absorption of cholesterol in the small intestine. The mechanisms of action are completely different, but both act to reduce serum cholesterol levels. Anthem approved the Zetia prescription and has been paying for it for roughly five years.

Here’s the situation: When I recently ordered a Zetia refill from Express Scripts, somebody there saw that Zetia required a step-therapy approach…other meds had to be tried and failed (been there, done that) before Anthem would authorize that prescription. Instead of filling the Zetia Rx, like they previously had, they called my doctor and told her that I needed to use something else before the Zetia could be filled. I don’t know who suggested Crestor, but that’s what they replaced it with.

I called Express Scripts. After a very long conversation, they agreed to fill the Zetia prescription. Today, I received a letter in the mail that they also cancelled my Lipitor prescription because Crestor and Lipitor are both statins…something I’d pointed out to the rep on the phone call.

I called them back. Will they reinstate the Lipitor prescription? No. Will they accept a return of the Crestor? No. If I send it back, it will be an unauthorized return and they won’t refund the $50 that they charged my credit card. Of course, I can always get a new prescription for Lipitor and that will supersede the Crestor prescription, but…

So…I’m treating it as unsolicited merchandise under the mail order marketing laws. I didn't order it. I wasn't notified ahead of time about the change. My credit card is on file for drugs that I order, not ones that I didn't. I buy a lot of merchandise on-line, but no reputable vendor sends out merchandise that isn't specifically requested...can you imagine Amazon doing so? I've filed a charge dispute with American Express and they’re taking care of it, but I wonder how many tens of thousands of people have had similar problems.

This seems like a class action lawsuit just waiting to happen. Comments?