This won’t be news to any BlueCross BlueShield health insurance client, but the Blues did something this year that added fresh levels of annoyance to the lives of patients and providers throughout Vermont.
The Blues made a big change in its prescription drug coverage. It hired Optum RX as its pharmacy benefits manager. Which led to new, stricter requirements for a broad array of prescription medications. This will presumably save the Blues some money, but it will do so by offloading a lot of pain and extra work onto patients and prescribers.
(Before I go on, tip of the hat to fellow blogger Matt Sutkoski, who posted his own screed on this topic a few days ago. I’d been thinking about this for quite a while, but his essay crystallized my own thoughts.)
If you heard the ringing of a faint bell at the name “Optum,” that’s because it was a key player in then-governor Peter Shumlin’s Vermont Health Connect fiasco. Step with me into the Wayback Machine, which is set for October 31, 2014 — just a few days before the election Shumlin almost fumbled away to challenger Scott Milne.
On that day, we learned that the cost of VHC would be $20 million higher than expected. And that, my friends, was not the bad news. There were a number of horrible particulars, some of which involved Optum. Its employees were said to be poorly trained and making mistakes. A top VHC official observed that Optum had every motivation to let the work drag on and on, because the longer the project the more money it made.
So yeah, a corporation with some definite baggage in these parts.
What is Optum doing to, ahem, Optum-ize the Blues’ prescription drug coverage?Continue reading