Express Scripts error affects pharmacy patrons

Letter lists Dreier as no longer being a ‘preferred pharmacy’

Leader Staff

A technical glitch by Express Scripts, a St. Louis-based integrated pharmacy benefit management company, has caused significant confusion for Network Health Plan (NHP) customers who fill prescriptions with Shawano’s Dreier Pharmacy.

Tim Dreier, owner and pharmacist at Dreier, reported a number of his customers, covered by NHP, began contacting him explaining their insurance provider had sent them letters stating Dreier would no longer be considered a “preferred pharmacy” for filling prescriptions. The communication went on to instruct Dreier customers for the need to move their prescriptions to another pharmacy, which is designated as a preferred provider, in order to have their prescriptions covered by insurance.

The letter was sent to NHP members by Express Scripts, the nation’s largest independent pharmacy benefits management company, which partners with NHP and other health insurance providers to oversee prescription benefits components under health insurance coverage.

Approximately 2,600 NHP members throughout Wisconsin received a letter after Jan. 1 notifying them of the status change among 19 pharmacies, including Dreier, and they were no longer categorized as a preferred pharmacy.

Jennifer Luddy, Express Scripts director of corporate communications, said Express Scripts was notified of the problem Friday and began in-person telephone calling to the NHP members who received the erroneous letter.

“We are contacting all impacted members and will make three attempts to speak directly with each member,” Luddy said. “We are also mailing an apology and correction letter to these members.”

Luddy said this type of error is “very rare,” and Express Scripts is conducting a thorough investigation to determine the root cause to ensure it does not happen again. While the error caused some confusion, Luddy added all prescriptions placed by NHP members at Dreier since Jan. 1 were processed at the correct price and co-pay levels.

“We were first alerted to this situation last Thursday when a customer came in and asked about why we were no longer accepting his prescriptions,” Dreier said. “We contacted Network Health and they admitted there had been a mistake and said they would work with Express Scripts to resolve things.”

Dreier added he had been in routine discussions with NHP late last year to confirm his status as a preferred provider and was assured everything was in order.

“Our customer base is extremely loyal and this situation created a great deal of confusion,” Dreier said. “I actually contacted a customer who was attempting to switch his prescription business to another pharmacy and when he heard my explanation of what happened, he said he wanted to remain with our pharmacy.”

Melanie Draheim, director of marketing, apologized on behalf of her company to Dreier Pharmacy and its customers.

“Since this situation was brought to our attention, it is our goal to ensure all affected members are informed as quickly as possible about the error,” Draheim said. “To date, 50 percent of the affected members have been contacted by telephone and we expect these contacts will be completed as soon as possible.”