Tuesday, December 4, 2012

How OptumRX legally screwed me out of $150

I take a number of drugs for Parkinson's.  One of those drugs is Requip XL (Ropinerole ER).  This drug is the same as the drug Requip (Ropinerole), except it has a time release capability which means the drug company that created it, could keep it from going generic, longer.  The advantage of taking the time release version is that you get a little bit of the drug over the whole day as opposed to large doses that taper off.  The good news is that the drug just went generic.  The bad news is that my prescription plan through UHC has not yet approved it for generic pricing.

Nevertheless, my pharmacy, OptumRX, in their infinite wisdom as a generic pharmacy sent me the generic version of the drug.  They also charged me the same rate as it would have cost if I they had sent me the brand name of the drug.  I called them and asked since I was paying brand name prices, I wanted the brand name drug.  They basically said, tough.  They sent it out and there was no indication on the prescription to fill as ordered instead of using a generic version of the drug.

Now understand this, I would prefer to have the generic version of the drug, but for generic prices.  The fact that I called them immediately upon receiving the medication and they did not call me back is indicative that they knew what they were doing.  I called back a few weeks later, and after discussing with a customer service representative and her supervisor, I asked to talk to the pharmacist who was in charge of making the decision.  I was told by the supervisor that the pharmacist would not speak to me and the decision was final.

The problem is, I have no recourse and the pharmacy knows this.  They are the only mail order prescription service that my health plan uses and they are on the whole much less expensive then going to the local drug store.  Nevertheless, I will probably be transferring this prescription to a local drug store, because then I will be able to see what I am receiving and quickly be able to determine whether the generic brand has been accepted by my health plan and the price will go down.

For reference, my plan offers Tier III drugs such as Requip XL for $170 for a three month supply, while a generic brand will cost $20.

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