Medication Management Mixup — Again! (MEDCO/Express Scripts and Dad’s ALF Both Messed Up)


Last week I was away from home all day on a local tour of one of the sights that school kids and out of town visitors usually see.  After living here over 4 years I have just started to do some local sight-seeing.  I haven’t felt free to make plans, but since dad is doing so much better this year, I am trying to do more.

Unfortunately, when I got home, there were two messages waiting on my telephone voice mail – both from Medco/Express Scripts about a medication ordered but not yet sent.  It sounded unusual because they suggested that if dad had 3 pills or less we were to call and talk to customer service.

The next day when I went to see dad, I stopped at the medication station to see if dad had all the medications he was supposed to have.  After keeping me waiting 15 minutes while she continued a telephone conversation, the medication aide finally spoke with me.  She was defensive and a bit hostile.

It turned out that dad was totally out of his blood pressure medication again.  He had received his last dose two days before.  I was quite upset as you know this had happened last year with the very same medication.

I tried to determine why they did not call me when dad’s medications ran low.  They told me it was not “their policy” to notify the family.  The policy was to call MEDCO/Express Scripts again – which they said they did 5 times!  They also are required to call the doctor when a resident is out of medications which they did first to reorder, and then to report two days in a row that he had no pills to take that day.  Still, they did not call me.

I reminded the aide several times that we had agreed last year that I would be notified when dad was almost out of pills.  She referred me to the nurse who was not available.

I went to speak to the director of the facility.  She seemed surprised when I told her dad was out of his blood pressure medication.  She said she needed some time to investigate and would get back to me.  I mentioned that since this was the second time this had happened, I planned to notify the state health department.  (I have not done that yet since I waited to see if dad ended up getting his pills and then we were into the holiday weekend).

I did get a swift oral response to the suggestion that I notify the state health department and felt this made them respond quicker than they otherwise would have (judging from the 5-day run-around I got last year!)

In the meantime I went home and telephoned Medco and spoke with customer service.  The woman I spoke with was very nice and could see right away that they had messed up.  She spoke with her supervisor and arranged to get five free pills to dad that day if his doctor called the pharmacy of my choice to order them.

I gave the name of the pharmacy.  Then the woman told me there was an indication that another order had been obtained from a different pharmacy for 30 pills that same day at a charge of $45.  She said I should cancel that $45 order to get dad his 5 free pills but would have to call the doctor for the prescription.  I decided to wait until I spoke with the ALF because I wanted dad to get his pills as soon as possible and not jeopardize that by cancelling the order in process.

Later that day, the director phoned me on speaker phone with the nurse.  It was a heated conversation as they sought to assure me that it was “not their fault” since Medco had failed to send the medications even after they called several times.  I reminded them that I believed they were equally at fault since they had assured me last year that dad would not run out of medications again and he did.  They again insisted I blame Medco.

I said: “I do blame Medco.  But I also blame you.”  Two wrongs do not make a right, and both the Assisted Living Facility and Medco were at fault so far as I could see.  We discussed the order from their pharmacy that was to be delivered that afternoon and agreed that it was not possible to cancel it.  I wanted them to go pick up the pills right away and they refused as it was not “their policy”.  The pills would be delivered before the end of the day, they said.  I was not convinced as it had taken 5 days last year for the same process.

The other thing that upset me was their lack of concern about dad missing his blood pressure medications for an uncertain number of days.  They said they had notified the doctor each day and since the doctor was not concerned, neither were they.  Now I am pretty sure they just send a fax to the doctor’s office and there is no way to know if she received the information or not.

Basically they said they have 46 residents and they have to stick to their own protocol with all of them and not get all concerned if one resident runs out of medications.  I said I am paying them over $4000 per month to oversee dad’s health and I expect them to do exactly that!  While they have 46 residents to oversee, I have just dad, and I will surely pay close attention to his needs.

After a brief discussion of how to make sure this does not happen again, we finally agreed on a process where they will notify me every time they reorder dad’s medications and I will follow-up by checking online and with them to be sure the pills come as expected.  If they don’t, I will be the one to call Medco as apparently they are not very effective at that.  They also agreed to pick up the $45 charge since it would normally cost dad less than $10 per month if he got it from Medco/Express-Scripts.

I still can’t believe they let dad run out of medications for the 2nd year in a row.  I still intend to follow up with the state even though he now has his medications both from the local pharmacy and over the weekend, the Medco medications finally showed up.

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About letstalkaboutfamily

I am a retired and was the primary caregiver for both my parents before they passed. I have children and grandchildren. This blog is an attempt to connect with other caregivers and share ideas and experiences. I hope you will let me know what worked for you if you had an experience similar to mine. The main issues I am going to talk about are elder care, death and dying, assisted living, family relationships and hoarders and hoarding. Other topics will come up as I address the issues and my relationship with other family members.
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14 Responses to Medication Management Mixup — Again! (MEDCO/Express Scripts and Dad’s ALF Both Messed Up)

  1. boomer98053 says:

    It is astounding to me that the facility staff would act so cavalier about the whole matter. Blood pressure medication is one of MANY medications that one should not suddenly cease taking. I question – as do you – the facility’s statement that the doctor was not concerned about one of his patients going without his BP medication. What a crock. I’m not certain in which state you live but you can find the local long-term care ombudsman in your area by going to: http://www.ltcombudsman.org. They need to receive a complaint relating to this matter; the more advocates involved in your father’s well-being, the better. And may I say that you are an outstanding advocate and are to be commended. Caregiving isn’t easy – it’s one of the most difficult jobs any loved one will take up in their lives – and you seem to be more than up to the task. I know you won’t let this matter go because when your father is helped, so too will the rest of the residents.

    • Thanks, Irene. I do plan to follow up and I want to ask at the state level what the requirements are for assisted living facilities and how often they run out of their resident’s medications. It just seems outrageous to me that they don’t take this more seriously! I feel like I have to report it so this will be “on the record” for this facility and so other families will know if they check before placing a family member. I believe all facilities probably have the same problems but I am curious about how often it happens at each place. I mostly want them to realize that I am watching this and they need to be more attentive before the medications run out. Thanks for your comment and link.

  2. Jodi says:

    Omg, I’m off to baseball practice with my girls but I have many thoughts, more noted as my director of nursing role. Why didnt they call you? Communication is biggest issue. I personally hate ordering from Medco, our nursing staff just talked about that but it’s just due to a time issue and automated system. They should have plenty of time. I would have picked up the meds and your cost. Errors happen, but that said you want to prevent them at all cost and learn from the error and not have it happen again. I’m sorry for this, as a nurse it frustrates me.
    I just said the same thing about moms place, for $5500, you think they could dust. 😦 let me know if you have questions. Med errors should not be faxed, our policy with home care. Hope tomorrow is better!!

    • Thanks, Jodi. I hate Medco too but that is the only place dad’s insurance covers. They insisted they never call family as their protocol is to just call Medco again and to notify the doctor when the resident misses a dose. I insisted they change protocol and always let me know so I can follow up. Someone has to be totally responsible to be sure medications are not skipped. If they are not dependable, then I have to watch over them. That is why I am notifying the state. I think there must be state requirement s around this issue and I want to know what they are. Thanks for your comment.

      • Jodi says:

        In Minnesota, they are cracking down on AL. Too many complaints and issues you are going through. I feel you can never go wrong with calling family. Maybe they can fix the issue, or help me fix it. If they saw they had one pill left, all they needed to do was call you for ok for an outside pharmacy until other med arrived. Simple and he would not have missed. Rules are meant to be bent a little with nursing, or just use common sense. Ugh.

      • I totally agree, Jodi. I feel like the ALF staff and the family are on the same team to provide the best care for the resident. I want them to be willing and anxious to keep me informed. I don’t like it when I feel they are deliberately keeping me in the dark. It looks too much like thy are hiding something. They would look better if they were totally honest and they would have fewer worries about reprisals later.

  3. Terry says:

    sounds like the same crap run around I get from Al’s facility. They can be beautiful in settings, anxious for monies, but lack in care

  4. sharechair says:

    Shouldn’t be. Just shouldn’t be.

    • Yep! That is why I try to remind them that I am personally holding them accountable. I think they would be more successful with Medco/Express Scripts if they insisted on talking to a human as I believe they just leave messages on the voice mail system. I was taken care of pretty fast when I spoke directly with a human. I want the Assisted Living Facility to care enough to insist on talking to a human too!

  5. Pingback: Filing a Complaint with the State Board of Health | Let's Talk About Family

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