I purchased a health insurance policy from Independence Blue Cross ("IBC"). The policy is titled IBC Keystone HMO Silver Proactive, took effect on January 1, 2017 and remains in effect to date. The policy covers prescription drugs which may be order by mail. IBC has contracted with FutureScripts, LLC to manage the policy's pharmacy benefit.
FutureScripts systematically violates its obligations under the policy it administers. FutureScripts representatives, responsible for accepting and processing medication orders, avoid providing coverage for approved medications through any means possible, and, in particular, by creating obstacle after obstacle to the filling and refilling of prescriptions. Even when a FutureScripts representative accepts an order, it is frequently later rejected during "processing" without notice to the insured. While FutureScripts does not explicitly refuse drug coverage, by subterfuge, FutureScripts effectively refuses drug coverage, in violation of its obligations under the insurance policy.
Let me provide an illustration. In January 2017 I submitted to FutureScripts a prescription for a 90 day supply of an expensive medication. A 90 day supply is the quantity typically provided by a mail order pharmacy. FutureScripts rejected this prescription, explaining that, for this medication, it requires a script for a 45 day supply. FutureScripts could provide no rationale for this requirement, but refused to fill a prescription for more than a 45 day supply. I asked my physician to provide a prescription meeting FutureScript's requirements, he did so, and I mailed the prescription to FutureScripts.
In January 2018 I mailed to FutureScripts a new 2018 prescription for the same medication and recently tried to order a refill. FutureScripts created a series of obstacles to this refill request. On May 4, May 9, and May 15, 2018, I spoke with six representatives of FutureScripts and IBC:
1. On May 4 I called FutureScripts. FutureScripts representative Denise told me I had satisfied the out-of-pocket maximum, and had a zero balance in my Rx Mail Order account. She was looking up the cost of the refill when she disconnected me.
2. I called back and spoke to FutureScripts representative Page who told me I had $98.02 remaining of my $1000 out-of-pocket maximum, that I had a credit balance on my Rx Mail Order account of $88.02, and that the medication required preauthorization. I explained that I had previously requested and received a prior authorization. I provided the prior authorization number, issue date, and expiration date. The representative said she could not access the prior authorization and that someone from the FutureScripts would call me back. No one did.
3. I called back and spoke to FutureScripts representative Erica. I requested to speak to a supervisor. The representative immediately disconnected me.
4. On May 9 I again called FutureScripts. FutureScripts representative Cindy told me I had satisfied the out-of-pocket maximum, however, there was a $10.00 debit balance in my Rx Mail Order account dating from a previous order. The total for that order was $98.02 which consumed the credit balance was $88.02, leaving the $10.00 debit balance. I explained that the FutureScripts had miscalculated my medical expenditures by $10.00, and specifically had not accounted for a $10.00 copayment I made to my physician in January 2018. I explained that I had mailed to the FutureScripts, in March 2018, proof of the copayment, specifically a copy of my cancelled check. The representative stated “We are not able to accept proof of medical co-payment from the insured ... IBC is responsible for updating medical expense payments. If a patient provides proof of medical payments, FutureScripts will not consider it because FutureScripts has no way to track medical expenses.” The representative refused to zero the balance.
5. I called IBC’s medical manager, Accolade, and spoke to representative Warren. The representative said she could not find a record of the $10.00 copayment. Although I had previously provided proof the payment to FutureScripts, I mailed a $10.00 check payable to FutureScripts on May 9.
6. On May 15 I again called FutureScripts. FutureScripts representative Virgil told me he could see my prior authorization, but nonetheless the FutureScripts system rejected the refill for lack of a prior authorization. The representative said he did not know why and had to speak to someone in the prior authorization department. He entered an order but this order was subsequently cancelled by FutureScripts without notice to me.
On May 19, 2018 I filed a written complaint with the Center for Insurance Oversight at the Center for Medicaid and Medicare Services, with a copy to IBC. Thereafter, following another telephone call, creation of a refill order and subsequent cancelling of that order by FutureScripts without notice to me, I was finally able to successfully order the medication. However, recently I received a letter, dated June 12, 2018, stating that I would have to wait 68 days from the fill date to refill the prescription. Since the prescription and fill is for a 45 day supply, this means that FutureScripts will not accept a refill request until 23 days after the supplied medication has been exhausted. In other words, the FutureScripts runaround is likely to continue.
Based upon this experience, I recommend avoiding insurance policies with benefits managed by FutureScripts.
FutureScripts Reviews
I purchased a health insurance policy from Independence Blue Cross ("IBC"). The policy is titled IBC Keystone HMO Silver Proactive, took effect on January 1, 2017 and remains in effect to date. The policy covers prescription drugs which may be order by mail. IBC has contracted with FutureScripts, LLC to manage the policy's pharmacy benefit.
FutureScripts systematically violates its obligations under the policy it administers. FutureScripts representatives, responsible for accepting and processing medication orders, avoid providing coverage for approved medications through any means possible, and, in particular, by creating obstacle after obstacle to the filling and refilling of prescriptions. Even when a FutureScripts representative accepts an order, it is frequently later rejected during "processing" without notice to the insured. While FutureScripts does not explicitly refuse drug coverage, by subterfuge, FutureScripts effectively refuses drug coverage, in violation of its obligations under the insurance policy.
Let me provide an illustration. In January 2017 I submitted to FutureScripts a prescription for a 90 day supply of an expensive medication. A 90 day supply is the quantity typically provided by a mail order pharmacy. FutureScripts rejected this prescription, explaining that, for this medication, it requires a script for a 45 day supply. FutureScripts could provide no rationale for this requirement, but refused to fill a prescription for more than a 45 day supply. I asked my physician to provide a prescription meeting FutureScript's requirements, he did so, and I mailed the prescription to FutureScripts.
In January 2018 I mailed to FutureScripts a new 2018 prescription for the same medication and recently tried to order a refill. FutureScripts created a series of obstacles to this refill request. On May 4, May 9, and May 15, 2018, I spoke with six representatives of FutureScripts and IBC:
1. On May 4 I called FutureScripts. FutureScripts representative Denise told me I had satisfied the out-of-pocket maximum, and had a zero balance in my Rx Mail Order account. She was looking up the cost of the refill when she disconnected me.
2. I called back and spoke to FutureScripts representative Page who told me I had $98.02 remaining of my $1000 out-of-pocket maximum, that I had a credit balance on my Rx Mail Order account of $88.02, and that the medication required preauthorization. I explained that I had previously requested and received a prior authorization. I provided the prior authorization number, issue date, and expiration date. The representative said she could not access the prior authorization and that someone from the FutureScripts would call me back. No one did.
3. I called back and spoke to FutureScripts representative Erica. I requested to speak to a supervisor. The representative immediately disconnected me.
4. On May 9 I again called FutureScripts. FutureScripts representative Cindy told me I had satisfied the out-of-pocket maximum, however, there was a $10.00 debit balance in my Rx Mail Order account dating from a previous order. The total for that order was $98.02 which consumed the credit balance was $88.02, leaving the $10.00 debit balance. I explained that the FutureScripts had miscalculated my medical expenditures by $10.00, and specifically had not accounted for a $10.00 copayment I made to my physician in January 2018. I explained that I had mailed to the FutureScripts, in March 2018, proof of the copayment, specifically a copy of my cancelled check. The representative stated “We are not able to accept proof of medical co-payment from the insured ... IBC is responsible for updating medical expense payments. If a patient provides proof of medical payments, FutureScripts will not consider it because FutureScripts has no way to track medical expenses.” The representative refused to zero the balance.
5. I called IBC’s medical manager, Accolade, and spoke to representative Warren. The representative said she could not find a record of the $10.00 copayment. Although I had previously provided proof the payment to FutureScripts, I mailed a $10.00 check payable to FutureScripts on May 9.
6. On May 15 I again called FutureScripts. FutureScripts representative Virgil told me he could see my prior authorization, but nonetheless the FutureScripts system rejected the refill for lack of a prior authorization. The representative said he did not know why and had to speak to someone in the prior authorization department. He entered an order but this order was subsequently cancelled by FutureScripts without notice to me.
On May 19, 2018 I filed a written complaint with the Center for Insurance Oversight at the Center for Medicaid and Medicare Services, with a copy to IBC. Thereafter, following another telephone call, creation of a refill order and subsequent cancelling of that order by FutureScripts without notice to me, I was finally able to successfully order the medication. However, recently I received a letter, dated June 12, 2018, stating that I would have to wait 68 days from the fill date to refill the prescription. Since the prescription and fill is for a 45 day supply, this means that FutureScripts will not accept a refill request until 23 days after the supplied medication has been exhausted. In other words, the FutureScripts runaround is likely to continue.
Based upon this experience, I recommend avoiding insurance policies with benefits managed by FutureScripts.
Dated: June 20, 2018