FMC ahead of the game or scamming?

[smcd23]

So last week in center hubby was told that his phosphorus binders would be delivered to the house from FMC. Apparently, it's all part of the health care reform and all bone medications and phosphorus binders need to come from the dialysis unit. It isn't supposed to take effect until next year, but FMC wants to get ahead of the game. Anyone else heard this? How does it work?

I have a few concerns, and zero time to call the social worker myself, so if anyone can help me or knows more, that would be great. First, I have a flex spending account and I have pretax money taken from my paycheck so I get reimbursed every time I fill his meds. His binder is $40 per fill. I want to make sure I get that reimbursement back! Also, how do we pay for it? I don't need ANOTHER bill each month, because I know I'd never see it in time because it would come addressed to hubby and my psychic abilities are not always that sharp. And I especially do not want 800 Renvela showing up at our door each month at $40 a whack. Currently his doc writes the script for 800, and it lasts over a month depending on how often he eats. I don't need FMC sending us that many pills each month and expecting me to pay for them also when we won't need them. We already have a huge box of "misfit medications" that hubby no longer uses, I don't need to start filling our spare room with misfit meds and expired phosphorus binders. I can't afford that monthly nor do we have the space to store them! And how does this work with private insurance?? I know my insurance company prefers I use CVS. How does that work - I better not have to pay more or I'll be shoving some phosphorus binders up someone's bum at the clinic real quick. 

Thanks for any insight anyone may have. The next free time I will have to call the social worker isn't until Thursday, and I've been stressing about this since I was told about it on Friday.

[Sydnee]

I don't "know" really. But the last couple of months FMC has pushed having them deliver Ed's binders. We pointed out that our insurance requires we mail order from them to cover the maintenance drugs. They now have it written in his records and don't bring it up. This is insurance Ed gets through work BC/BS with CVS prescription coverage.

[cattlekid]

I am in the same boat. They tried to push me into the DaVita pharmacy, and I told them flat out that I wasn't going to use it because it doesn't work with my insurance. Well, they wouldn't take no for an answer until they called Caremark themselves. So you are right to question this if you have private insurance.

[Joe]

My situation is the same as Sydnee's in that all of my maintenance meds have to come from my insurance companies mail order site. When this got started, FMS sent me a couple of my meds, along with the bill for my co-pay. I gave them back to the clinic and told them to stop having FMS send me maintenance meds. That's the last I've heard from them.

[rocker]

Mail-order pharmacies are another huge profit center.  As such, the clinics sell them aggressively.

[smcd23]

Thank you so much everyone! I have Federal BCBS so I know it's a little more flexible than commercial BCBS, but I am going to call them at lunch tomorrow and find out if this is going to fly for us or not. I am thinking not. I like being in control of when we get Tony's meds, if we need them, if we don't and I can plan for paying for them when money gets tight. I am not and was not looking forward to this, but I am hoping a simple call to my insurance tomorrow can get me a letter to give to the clinic to say bugger off!

[thegrammalady]

as of 2014 you will not be able to fill prescriptions for binders at your local pharmacy. they will have to be filled through fmc pharmacy or davita pharmacy or whatever HOWEVER fmc cannot force you to do it prior to 2014. it should still be covered by your insurance no mater what you have. when my center brought the paperwork to me i just said no thank you and they went away. i am however already "registered" with the fmc pharmacy because they pay for my lidocane cream as they must by the cu rent medicare laws.

[smcd23]

I want to know WHY they can't be filled at local pharmacies. I am going to have to go buy the cliffnotes version of Obamacare - apparently someone wrote one. I need more information, but I am not liking the way this is sounding one bit.

[Bill Peckham]

I hate to complicate things even more but there has been a change to when binders and Sensipar need to be dispensed by the units. There was language in the recent "Fiscal Cliff" legislation that delays the implementation of that part of the payment bundle until 2016. http://ihatedialysis.com/forum/index.php?topic=28144.0

When Medicare published the new reimbursement rules the reason Medicare gave for including phosphate binders, vitamin D and calcimimetics in with the per treatment payment (aka the expanded bundle) is that bone health should be part of the renal replacement care they are paying dialysis providers to provide. Just as they see your anemia management as part of the care dialysis providers are paid to provide.

At first there was a lot of reporting (NYT) that this language was a give away to someone - most likely Amgen - but followup analysis by the Congressional Budget Office showed that the delay will save Medicare money.

Anyway - sounds like FMC sees this as a valuable source of revenue and is using confusion about the rules to advance their corporate interests. FMC is not yet being paid, as part of the per treatment reimbursement, to manage your bone health, if they're providing your Sensipar/binders then they are billing your Part D or private prescription drug policy.

[smcd23]

Thank you Bill. I just read this to my husband, and I guess another patient had called out the social worker or dietitian who told my husband, and she came to him at his last treatment and told him that she didn't know about the delay and that she would check to see what our copayment would be through their pharmacy to see if we can save money. I just told him that unless FMC can give us the binders for less than $40, we will continue to fill them as we need them at the local pharmacy (that my insurance prefers we use anyway).

[ms2116]

It is true that it is not until 2016 which is a change since last year when the government changes it from 2013 to 2016 This is when dialysis clinic need to provide renal medications.   FMC is now pairing with Davita to provide these medications because Davita has been in the pharmacy business longer.  FMC launch of their own pharmacy and didn't go well.  My concern is for the person paying 40.00 for renvela, speak to your socail worker...because if you have commercial insurance they can give you a 5.00 co-pay card that can be used at any pharmacy including mail order.  Or you can go on line and google it an print one your self.  You need to make sure the pharmacy has all the information on the card in order to get the help.  If you don't ask the socail worker if there is any other help  there often times is.

I am sure they are making money on this until 2016....but at least if there is a problem your clinic staff or socail work can more readily help you with the pharmacy.

[smcd23]

My concern is for the person paying 40.00 for renvela, speak to your socail worker...because if you have commercial insurance they can give you a 5.00 co-pay card that can be used at any pharmacy including mail order.  Or you can go on line and google it an print one your self.  You need to make sure the pharmacy has all the information on the card in order to get the help.  If you don't ask the socail worker if there is any other help  there often times is.

We used to pay $40 for the Renvela, but the social worker or dietican checked to see how much it cost through their pharmacy, and it cost $5. So we are getting that one mail ordered. We can't use copay cards, because I have Federal health insurance because I have a Federal job. Apparently the copay cards don't work on government subsidized or funded insurance, which mine partially is because my employer picks up part of it.

However the new annoyance with this is that they had him on autoship. So every 30 days we got 450 pills - when they ordered it, they had figured him taking 2 pills which each snack and 3 with each meal, which isn't what he takes - he takes 2 with each meal and snack, approx 10 pills a day, so we were getting 150 more pills per month than he ever needed. And when she put in the first order, I had just picked them up at the local pharmacy a week before. So for awhile we had enough Renvela to fill a bathtub. After the first order she allegedly was going to take it off autoship, but then we got another shipment and I complained, and told her I wasn't paying for them until he actually started using them. I guess they listened that time because we have not gotten anymore,  and they have not yet got their $5 check