Tuesday, March 22, 2022

The ongoing disaster of the new UC Health Insurance Pharmacy "benefits"

Recently I posted to Twitter about the disastrous new University of California Pharmacy Benefits system.
In summary, I got a letter in March that warned me of something that was about to happen in January (that is, in the past).  And what was about to happen was bad - cutting off coverage of my insulin.  And the system in place for trying to even find out what was going on and what to do about this was a disaster.

I note, this generated an enormous response and it was clear that this was not just me experiencing the disaster of their system.

I used the threadfreader app to make this into a more easily readable thread here: https://threadreaderapp.com/thread/1500934973775249412.html

A few people pointed me to some contacts at UC Davis to reach out to and I did.  They were both great and very helpful.  They told me that the UC was working on dealing with many of these issues and some of those responses were rolled out quickly. 

And I posted about how these efforts were sort of helpful but not ideal. For example

On March 21, I got a detailed email from the University of California apologizing for the situation and detailing many changes to apparently try and help fix things.  I mean, they never should have done this and used this incredibly cheap, low grade system.  But at least they are trying to fix things.

Below is the email from UC. More about this in a bit but I wanted to share the full text for people to see here.

An important message from UC about your pharmacy benefits

Dear Jonathan,

We are writing to acknowledge — and apologize for — the problems many members of the UC community are experiencing with Navitus Health, a new administrator of pharmacy benefits for UC employee and Medicare PPO plans, and to let you know what we are doing to fix the problems.

Last year, University of California Health (UCH) and UC Systemwide Human Resources selected Navitus Health to administer pharmacy benefits, starting Jan. 1, 2022. This decision was made following an extensive formal bid process, conducted by a committee with representatives from UCH, Systemwide HR, UC faculty with pharmacy expertise and UC’s retiree association. 

Navitus was selected as the partner that could provide UC with the best overall flexibility, service, and affordability. However, since UC’s transition to Navitus Health, we have heard from too many members who have been negatively impacted by this change. 

Some members have had to change prescription drugs, been required to complete time-consuming authorization processes and experienced denials by Navitus, causing unnecessary anxiety and frustration. Navitus failed to meet the scheduled target date for mailing a clinical transition letter, causing hardship and worry for faculty, staff, retirees and their family members.  

Additionally, like many employers Navitus has faced customer service staffing challenges, leading to wait times that far exceed Navitus’ standards and UC performance guarantees. Among other things, this has put undue pressure on benefits professionals at UC locations and in the UC Retirement Service Center and the UCPath Center, as they have worked to provide support that should be handled by Navitus.

We take these problems — and our responsibility to ensure that members of UC health plans have access to the prescriptions they need — very seriously. UCH and UC Systemwide Human Resources have been in constant communication with Navitus, and we want to let you know what we are doing to fix these problems.

Support with member transitions
  • Due to the delay in mailing clinical transition letters, Navitus has provided an extended transition period to the end of April for drugs that are not covered. Extension letters and an email campaign were recently initiated.
  • Navitus will call members who need to transition to new medications directly and offer help with authorizations, denials, and appeals. Those who have experienced a denial for a Not Covered/Non-Formulary medication will also receive a phone call offering help. 
  • UCH, Alliant (a UC consultant) and Navitus will audit and review the protocols Navitus uses for denials to ensure they are in alignment with Navitus internal guidelines, industry standards and Medicare guidelines – and to identify and correct any gaps. 

Customer service improvements
  • Navitus has committed to adding an additional 35 customer service representatives (an increase from 125 to 160) by the end of April, and hopes to add another 15 staff after that, along with additional support for UC benefits professionals.
  • Navitus has also added two more personnel with pharmacy clinical expertise to help UC benefit professionals support members.
  • In addition, Navitus is exploring a concierge-type customer service model to ensure UC members receive the dedicated assistance they need.

Again, we sincerely apologize for any difficulties you or your family members have experienced during this transition. We are committed to you receiving the critical health care you deserve, without unnecessary inconvenience or frustration.

Cheryl Lloyd                                                    Dr. Carrie Byington
Vice President                                                 Executive Vice President
Systemwide Human Resources                      University of California Health

Please do not reply to this message. Replies to this message are routed to an unmonitored mailbox. 

UPDATE 3/25/22

So some updates. I posted about the letter here and to Twitter.


And here is the whole thread on Threadreader.

I shared the letter from UC and also some comments.  

One key point - the saga was covered by Caleb Hampton in the Davis Enterprise.

And then I posted that I had received a communication from UCOP that they would tell Navitus to cover my insulin. 

Alas, I then got a call and letter from Navitus saying that they were denying my request for an exemption for one of my insulins and approving a request for another.

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