State steps in after problems with mail prescriptions for retirees

By DAVID BROOKS

Monitor staff

Published: 02-22-2024 3:42 PM

The change of companies overseeing mail-order prescriptions for roughly 11,000 retired state employees has resulted in so many problems since the start of the year that the state may fine Anthem Blue Cross, the company that won the contract.

Gov. Sununu said “penalties will be assessed,” at Wednesday’s meeting of the Executive Council, a hearing called after weeks of complaints that prescriptions were not being filled, were incorrect, required extra steps or led to overcharges.

One person who has faced problems is Carol Royce of Concord, who says she has spent “10 hours on the phone – I’ve documented it – ” trying to get mailed refills that had happened smoothly under Express Scripts, the company that had the contract until the start of this year.

“You get cut off, get switched to different people, get cut off, get cut off. Nobody knows what they’re doing! One says ‘That doesn’t make sense’ with a big sigh, one says, ‘Oh my God!’ ” she said.

Royce said she has heard from friends who have faced similar problems, sometimes made worse by not knowing how to use computers or cellphone apps, including one called Sydney, that are now central to the system.

Last summer the state awarded Anthem with the $68 million contract as the Medicare Advantage provider for state retirees and dependents. The switchover happened Jan. 1 and complaints began soon after.

“Switching from the old mail order pharmacy, Express Scripts, to the one specified by Anthem took me four hours over a two-day period,” wrote Jim Merrow of Penacook in a letter to the Monitor.

The problems led to Wednesday’s meeting of the Executive Council, which approves most state contracts, where commissioners grilled Administrative Services Commissioner Charles Arlinghaus. Executive Councilor Janet Stevens, R-Rye, led the charge, telling the state it had to step in. 

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According to press reports, Arlinghaus said retirees with issues should call the state benefits line at (603) 271-1432.

Royce talked about her dealings with Carelon, a health service firm created in 2022 that is a subsidiary of Elevance Health, the massive insurance firm that is the parent company of Anthem Blue Cross Blue Shield.

Looking back at her career, Royce recalled the complexity of switching large back-end systems that control things like billing and customer data, and how those changes require extensive preparations. “They always had to be tested and tested – we had to know they worked before they go live.”

In a statement, Anthem said it had “established a dedicated phone line with expanded call center staffing for retirees who encounter any issues with prescription fills or refills. In addition, we established a dedicated concierge team to proactively contact state retirees who may have questions.”