Could Medco Equal "Deadco"?


After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn’t received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies.

If you’re like most Americans, you want to try to save some money. One of the ways that patients can save money is by cutting prescription costs.

Enter Medco. Medco is a mail-order pharmacy that receives prescriptions by mail or by facsimile and then sends patients their prescriptions by mail. Often, the prescriptions are for a three month supply of medications. By having warehouses instead of multiple “brick and mortar” retail buildings, Medco can save costs and presumably undercut the competition. An analogy might be that Medco is the “Netflix” of the pharmaceutical industry.

With the cheap prices come problems, though.

We probably see a couple of patients a month in the emergency department who have run out of medications because their shipment from Medco or some other mail order pharmacy hasn’t arrived. Most of the time the patients can’t get into see their family physicians and are just requesting a week or two worth of pills to “carry them over” until they get their shipment. Some patients try to split pills or take their medications every other day in order to hold out as long as they can.

Mrs. WhiteCoat is a family physician and she sees the other side of the Medco problem. When she faxes renewals for her patients’ prescriptions, her faxes are routinely lost. Doesn’t matter that she has a confirmation sheet. Medco makes her dig up the chart and re-send the renewal. Many times, she only finds out about the non-receipt of her faxes after her patients call her in a panic because they have called Medco’s customer service center, were told that no renewal was received, and are almost out of their medications.
Mrs. WhiteCoat also regularly gets faxes from Medco requesting that she change her patients’ prescriptions to a “preferred” medication. Unless she signs them and faxes them back, then calls to confirm with a pharmacist (not another physician) that patients really need the medication she prescribed, Medco won’t release the prescription and the patients don’t get their medication.

What’s the big deal – it’s only 5 or 10 minutes, right? Wrong. Many times it is more. Not too long ago, Mrs. WhiteCoat’s nurse was on the phone for 80 minutes getting prescriptions straightened out for 4 patients. That was time that the nurse couldn’t help patients in Mrs. WhiteCoat’s office and represented a loss of almost an hour and a half of the nurse’s salary to Mrs. WhiteCoat. Even if it is only 5 minutes, if you multiply 5-10 minutes times hundreds of patients, you end up with a significant amount of time each month of phone tag, waiting on hold during uncompensated phone calls, and hoops to jump through – just to get your patients their medications.

The mail order pharmacies may actually cost patients more money in the long run. If patients can’t reach their physician and have to come to the emergency department or urgent care center when Medco doesn’t get them their prescriptions in time then they may have to pay a copay or other out of pocket expenses for the extra doctor visit because of Medco shenanigans.

So if there is a mix-up in paperwork … or if Medco conveniently doesn’t get the faxed prescription for a patient’s medications (even though the physician has a confirmation page showing that the fax went through successfully) … or if Medco pharmacists think another medication might be better for you than the one that your physician prescribed … you just might not get your medications before you run out.

If you don’t get your blood pressure medications and you have a stroke … well at least you saved a few bucks on your prescriptions – when you finally get them.

So a question for the attorneys: Suppose an insurer or employer’s health plan only allows their enrollees to get these mail order prescriptions. No prescriptions from local pharmacies or national chains allowed. Now suppose that a patient has a stroke because they didn’t get their medication refill in time.
Can the insurer or employer be held liable for contracting solely with a company that is suspect in its duties?


  1. The VA is even worse. A friend of mine takes narcotics for chronic pain due to wounds sustained in combat. A few times the VA mail order system has lost hundreds of tablets, or he’ll mysteriously get an extra package (with hundreds of tablets). Now he just saves the extras for when they “lose” his meds.

    If you have a civilian prescription couldn’t the patients get it filled at a retail branch and pay for the medication out of pocket? They still have control over whether they would take the medication, just not how much they would have to pay for it. I can see how this is unfair, but the patient still has access to their meds (just not under their insurance).

  2. I hate medco. I used to use them myself for a prescription (generic OCP) and they NEVER got it right. They were taken continuously (a la Seasonale) so three month’s supply was actually 4 packs. But they ALWAYS sent 3 packs. I’d call to tell them so, and after lots of transfers and “you’re doctor must have made a mistake”, I’d get my 4th pack. And they would count it as a refill. So instead of a six refills, it would only be three and I’d have to call my poor doc and get ANOTHER prescription and start the process over again. It was a mess!

  3. isn’t there some legal provision that immunizes insurance companies from liability when they try to ration care?

  4. Don’t forget managing all of the prior authorizations with lab values proving the drug is needed to the insurance. It is especially frustrating when the patient can only state they have medicare part D and you must call the pharmacy to find out the plan in order to search out the forms required.

  5. I believe that the insurance company is immune from suit in most cases, if you get your coverage through an employer. Bad, bad idea. We have no recourse except to complain to our states’ Departments of Insurance.

    But there’s something I don’t understand in this post. When I’m running too low to wait for Medco, I just call my doctor’s office and ask them to send 30 days supply order to the local pharmacy and 90 days to Medco. My insurance company pays for the local prescription without complaint, so why are patients going to the emergency room when they run out? Why not call their doctors’ offices for a short-term prescription at a local pharmacy?

    • You could easily think that your shipment is coming that day, then when it doesn’t show up, try calling your doctor, and whoops, they’re gone for the day and it’s now a 3 day weekend.

      Also, some insurance plans will not pay for retail pharmacies at all.

      • My situation is I have been on Lexapro for maybe 1.5 to 2 years now. Suddenly, my insurance company tells me I can no longer fill this at my retail pharmacy and I MUST get it filled through the mail order pharmacy (Medco).

        My doctor sent a new prescription to Medco electronically and I had him send a new Rx to my retail pharmacy just in case so I had an Rx ready if I didn’t get my mail order meds.

        I had 2 days left, so I called my pharmacy for a refill (I found I still had 1 left on my current Rx). Yesterday I went in and they tell my they couldn’t fill it because it is no longer covered… I guess they’d rather tell me this in person instead of calling me when they tried to process the claim??

        I called my insurance company.. now I need to call my doctor’s office to try to get them to call and get a prior authorization so the retail pharmacy can fill my rx.

        I guess I’m going back to the pharmacy today and paying out of pocket for a few days to get me through the 3-day holiday weekend.

  6. My employer tried to blackmail people into using one of these services. You had to call to opt out, or pay full price at their OWN pharmacy. When you called to opt out, the mail service kept pitching you for their product and delayed accepting your opt-out.

    The blackmailing was discontinued after a huge outcry.

  7. The only basic problem we’ve had with Medco is their insistence that my wife not get Prevacid when her physician has told them that the generic formulary has very unpleasant side effects. Since Medco is essentially a “paper mill” for my former employer’s benefits to us, a call to my retirement representative gets it changed BUT we pay a really, really big price for Prevacid even with just a copay.

  8. I would invite your readers to contact their local “brick and mortar” pharmacy if they run into this predicament. If they bring me a current bottle with all the information, I will just fill it and fax the prescriber for a short term supply until they can get the mail order prescription straightened out. I know a lot of pharmacists will hide behind “it’s my license,” but I was taught that as long as what I do is in the best interest of the patient, there will be know problem. Call around, you will eventually find someone who will help you.

  9. Medco is a huge, stinky, hot mess.

    I used to use Medco when I was under my parents insurance. They were ALWAYS trying to switch my Prevacid to Prilosec, when I had pH probe studies showing that I had 4x the amount of reflux on Prilosec versus Prevacid. I had healing esophagitis and they wouldn’t send me my Prevacid until my GI doctor told them I couldn’t have Prilosec. I would ALWAYS lapse as a result of it- yeah, that’s gonna help my esophagitis.

    “Was the prescription written for Prilosec?”

    “No, that’s why we faxed your doctor!”

    “Don’t you think my doctor would have written it for Prilosec if that’s what she wanted me to take?”

    “But this will save you money!”

    “She’s well aware Prilosec has a generic and Prevacid doesn’t, and that Prilosec is therefore cheaper for you. But she wants me to have Prevacid, she even wrote DAW in the box!”

    “But we have to wait for the doctor to call back.”

    “Was there anything wrong with the Prevacid prescription?”


    “So I have a legally written prescription for a drug I’ve been on for years and that you would pay for if I got it at a different pharmacy, that you are refusing to fill?”

    I asked this person what their qualifications were, and essentially there were none. When I asked to speak with a pharmacist, I was refused. Ugh.

    On another occasion we had been having an unseasonably warm 95 degree May. I got home to find my 3 month’s supply of insulin sitting on my
    front stoop baking. There wasn’t a single ice-pack in there. The vials were warm, even bordering on hot, to the touch. When I called Medco to complain I was told that they can reach 80 degrees without damage. When I told them it was 95 degrees out, they told me that they typically look at normal weather patterns for parts of the country and decide if it needs to ship with ice. They did agree to replace it, but had I not been able to get more from my doctor, I would have been without insulin.

    After those experiences, I stopped using Medco. I use a CVS now. Just yesterday I went to fill a prescription for a “24 hr” version of a drug. They told me by switching to the 12 hr version of the same drug, my co-pay would drop from $45 to $5, and would I like them to call my doctor to get it changed? That’s how it should be done.

    My father still uses Medco and regularly calls me asking how bad it is if he goes without Advair for a week or if there’s anything OTC he can take to replace his Coreg til his shipment gets here.

    It’s scary.

  10. As a counterpoint, I’ve used medco for several years and am content with it. The trick is to make sure you have at least a month’s supply on-hand when ordering refills.

    With five active prescriptions, it can get annoying keeping track, but having done so, I get 3-month refills from Medco rather than the 30-day refills that I can get from the local pharmacies. Overall, from a customer perspective, less hassle.

    Although I’d *never* order anything that had to stay refrigerated.

  11. I have been using Medco/Accredo for my day to day medicines for several years. My health plan forces me into it by making me pay full price for any medications that I have to take for more than 30 days if I buy them at a local pharmacy. Overall, I’ve been very happy with my service from Medco. I’ve been on two medicines for my arthritis that require refrigeration, and I’ve never had issues with Medco not putting in ice bags and overnighting the medication. You do have to plan for a two to three week processing and shipping lead time when ordering refills. That can bite you if you don’t regularly count your pills to make sure you have enough. Medco has substituted cheaper alernatives to some medications at times, but usually works with me and my doctor to get it corrected.

    • Mama On A Budget on

      Ah ha… Now that you mention Accredo, I know who WC is talking about. They tried to screw with my mom’s medication constantly. I had never heard of Medco.

    • Oh, is Medco the same as Accredo? I used them for a while for my MS drugs. They were mostly fine, except that they were terrible about sending me sharps containers. They used to ask every month if I needed one, and I finally started telling them yes every single month, which got me one about every 4-5 months – they wouldn’t put it in the box the rest of the time.

      I am now on Aetna, and they always send a sharps container when I ask for it, but they have screwed up my mailing address multiple times in different ways, once causing my perishable drugs to be delivered to a house a couple blocks away.

  12. We found it to be an awful hassle. They routinely don’t send the medication in time to have no lag time in doses. If you call to complain, they will offer to let you speak to their pharmacist to discuss the risks of missing those doses. I was so disgusted–I told them that I didn’t need to speak to their pharmacist because our DOCTOR already decided that this medication was to be taken every day. Gah!!!!

    It does help to keep a supply on hand, but that is made harder when it’s a medication is being used with a variable dosage during a ramp up or taper down.

    We also found out that DH’s diabetic test strips cost $125 through them, but $80 at the store. It’s not cost-saving convenience when you’re paying over 50% extra for the privilege of it! But I guess it does create jobs and boost profits if you want to look for a bright side to the lies about how much they can “save” you.

  13. I’ve only had experience with Medco on the provider side of things.

    It’s quite time consuming to get prior-approval for a lot of patients. In the end the prior-approval is usually a 1-3 question form that’s faxed to the office. However, to get said form, the individual from the provider’s office (me) has to spend a good 10 minutes on hold waiting for the first CSR, only to go through everything to be passed to another CSR.

    Then there’s the repeated faxing of the same form.

    My favorite Medco event is when they fax our office a form for a patients medication. Thing is that the doctor’s name is the same as another physicians. Problem is the patient and the prescribing physician are 2500 miles away on the opposite coast. Yet Medco time and time again sends this same form to our office. (I’ve lost count of the number of times I’ve called them about this).
    [Even better, it’s not a drug that the doctor in our office would prescribe!]


    No idea on how their mail order works over all. Though one patient used to constantly complain about it.

  14. Maybe you and Mrs Whitecoat should spend some time in a pharmacy and see how much time we waste “fixing” MD’s mistakes. We too spend 5 or 10 minutes (and many times more)waiting to get prescriptions straightened out because the MD goofed by not dating the rx, or forgetting to sign the rx, or for writing a non existent strength, over max doses,drug interactions, etc., etc., etc. – which is time that the Pharmacist can’t help other patients in the pharmacy. Unlike Mrs Whitecoat, who can get her nurse to handle prescriptions that need to be straightened out, we the pharmacists have to handle most of the calls to straighten out the problems. So we too end up with a significant amount of time each DAY of phone tag, waiting on hold during uncompensated phone calls, and hoops to jump through – just to get your patients their medications.

    What’s the saying… people in glass houses shouldn’t throw stones!!! (and no, I do not work for Medco)

  15. My husband used medco and to try and save money we decided that we would fill one of my scripts as it would cost $65 per month opposed to $110 every two weeks. The first script came no problem, did the refill and almost 3 weeks later hadn’t come. Called medco to find out they sent it to an address that we hadn’t lived at in over 8 years. When they sent a new one they counted that as the 3rd refill even we never received the 2nd refill. When you call them you get a different story from every person that you speak with, they have no way to track an order even with narcotics. I’m sure whoever got my refill at my old address was happy to receive free drugs.
    We did try to stick it out and lasted only 3 months and went back to neighborhood pharmacy for my as well as my husband’s sanity.
    BTW Whitecoat long time reader first time to comment, I really enjoy your blog and you sound like a great doctor.

  16. Pingback: Tweets that mention Could Medco Equal “Deadco”? | WhiteCoat's Call Room --

  17. Mama On A Budget on

    When I was insured, we had Express Scripts – very similar (maybe even part of Medco?). I was put on an extremely expensive (almost $800/mo retail) steroid that was supposed to target one particular spot in my digestive tract. I had to fill it in retail first for one month, then get reimbursed, but they only reimbursed it for 50% instead of the everything minus co-pay. When I called to complain, I was told I’d have to go through the appeals process with my company, write a heart-felt letter, etc. The first mail order came just fine. My 3 month refill would have been ordered the first month we were self-pay for insurance, so we bit the $2100 one month copay to get the $2400/3 months drugs. Only they decided that that they weren’t willing to cover it unless I switched to generic prednisone – which wasn’t at all what I was on – so they only sent 200 pills instead of the 270 I had ordered. So I started doing the reduce the daily dosage to stretch it… until I ran out and haven’t been on it since.

    They did the switch around thing with the prescription prenatal I was on, too. I guess the manufacturer stopped making the one I was on for years and years, so they just sent something completely different. Maybe for most people that would be okay, but I have celiac disease, and they couldn’t guarantee the binder was GF. But, since it was in my possession, I had to keep it and pay for it – they couldn’t take it back.

  18. We have Medco on our health insurance plan and I am guessing have used it for the last decade.

    I have to say ..that I don’t have any complaints at all.Only this past December did they make a couple of mistakes. It was after talking with the reps ..they didn’t follow through with what we discussed per my requests. I figured that perhaps they were new.

    I have to say ..that Medco med deliveries are *expedient* and we only use the standard shipping. We have the meds within 2 days ..3 max, unless a weekend/Friday order.

    *** The only thing I have been concerned about/wondered that the meds can get hot/war, in the mail box and possibly during shipping and would that compromise the medications?

    *** A couple of times husband was in that predicament such as your wife experienced with running out of meds and I had to contact his pcp to get a few from the pharmacy or the pharmacist just gave him a few. That was my error in not ordering when he asked me to.

    Imo, if the patients order early enough *before* they will run out ..they will have the meds delivered in time.

    I am sorry that your wife and med professionals have to jump through all these hoops though.

    I miss my first pharmacist. a never forget your first. 😉 he was fantastic and he had another pharmacist there I called Dan Dan ..the pharmacy man! 🙂 Anyway ..the head pharmacist got out of the business because he felt he couldn’t compete with the big pharma warehouse companies and went into retail..owning other businesses.

    I loved having someone that owned their own business, that knew us and I miss that personal touch/relationship that one develops when a steady customer. Sorry for digressing.

  19. Aetna’s mail order and Health Care Service
    Corp.’s (BCBSIL, BCBSTX, et al) captive
    mail order Prime Therapeutics are just as
    bad. Aetna’s 90-day generic copays are so
    stiff that I shop among local pharmacies
    (mostly CVS, Costco and Target) to pay less
    and get my rxs faster. I used to be able to
    fill all my 90-day scripts at CVS, which I
    really miss – I felt a lot safer knowing
    the people filling my rxs, and knowing they
    were watching out for me. If I could afford
    full cash price on all my meds, I’d get them
    all filled at CVS. But that will have to
    wait until I hit the Powerball or Megamillions
    jackpot. Fat chance.

  20. I use Medco for my meds and so far, I have not had any problems. I never fax anything though – I just mail it in. Of course this takes some planning. I send it in about 2-3 weeks before I am expected to run out of my meds. I also make sure I get maximum refills so usually, I can just go online and re-order. In those cases, I get my meds in less than a week.

  21. I always order on line from MEDCO. They keep the credit card info and so it’s easy. You can also see how many refills and they will contact the physician’s office for a new order.

    I also like being able to go on line at the end of the year to get printouts of the family meds used for tax deductions.

    I still miss the personal touch of a family pharmacist.

  22. I’ve been using Medco while in the US and overseas. never had a problem, even with the slow mail. It’s great, because they will give you a three month supply and I can reorder after a month or so, online. Never had any problems with that.

    I have had noticed that it takes about 2 weeks for a new prescription to be processed. I do my own- don’t have the MD offices do it. Some because they don’t anyway, and in others I am just more comfortable keeping track of the process myself. I admit, sometimes I choose not to take medications that are prescribed. But for the things that I will take for long term, I have the physician write two scripts- one for a 30 day supply and one for the 90 day supply. The 30 day supply goes to bricks and mortar, the 90 day to MEdco. More than adequate coverage.

    I have had some delays and confusion when my insurer required prior authorization for a non-formulary item. Note, that this was an issue with the insurer. Medco informed me of what the insurance response had been, and i followed up with the insurer. They told me what I needed from the MD, I got that, then faxed it ot the insurance company. As soon as that was cleared, I got my prescription from MEdco. I am guessing that there is something in the insurance carrier’s contract with medco which is causing the delays, and going to the payor is more productive than using the conduit.

  23. I’m thankful my daily meds aren’t expensive. I’m scared to death of mail-order, and don’t want the hassles of arguing continually for my brand of choice. It was hard enough getting the doc to prescribe it (desiccated thyroid-yes, it really works better than synthetic for me). There IS a difference whether the insurance companies accept that or not.

    My med costs me $7.95 a month cash; it would be a $15 if I had my insurance take care of it. Hope I don’t end up ever needing more expensive stuff because hubby’s work insurance just pushed everyone on mail-order. Blecchh.

  24. I think the underlying theme here is a takeover of the whole prescription market by a few companies at the expense of local markets. As it is already happening in the food, telephone and internet industries which are getting concentrated into a few hands, the people, patients, doctors and local pharmacies are gradually losing power. Generally noboby complains because things have been going quite smoothly. But if an emergency occurs (and it’s bound to occur, see ), things go at another price. Let’s say a local community rallies against the government because of another multitrillion Wall Street bailout. These communities can be punished by large conglomerates in the drug, food and telecommunications industries. Local pharmacies won’t be able to refill patients prescription because they have already downsized, lost their know-how or client networks, or simply are out of business. The same thing is happening in the food industry and the only thing these conglomerates need is to prohibit local gardens ( ). Similarly, have you noticed that if you are out of your home and don’t own a cellphone is almost impossible to make a phone call anywhere in the U.S.? Well, cellphone and internet communication can be shut down by flipping a switch. They can do it, they own it, they control it, but you don’t nor your neighbor. The day you fight back, that day you won’t eat, won’t talk on the phone, won’t get online nor take your asthma medication. And it doesn’t matter if you have guns, you won’t be able sustain a peaceful/less rally with your stomach empty. In our modern cities where almost half of population are some kind of clerk, is expected that nobody farms anymore, nobody knows how to farm, but who would when we’re being fed cheap, genetically modified food grown God only knows where by the agribusiness industry. So let us know more about your prescription benefits with large conglomerates.

  25. Rephrasing it.

    I think the underlying theme here is a takeover of the local and independent prescription market by a few large companies like Medco. As is already happening in the food, telephone and internet industries which are getting concentrated into a few hands, the people, patients, doctors and local pharmacies are gradually losing power. Generally noboby complains because things have been going quiet and it usually takes a lot of time to achieve it. But if an emergency occurs (and it’s bound to occur), things go at another price. Let’s say a local community rallies against the government because of another multitrillion Wall Street bailout. These communities can be punished by large conglomerates in the drug, food and telecommunications industries. Local pharmacies won’t be able to refill patients’ prescriptions because they have already downsized, lost their know-how or client networks, or simply are out of business. This might seem farfetched but look at the ‘agribusiness’ industry which has virtually put local farmers out of business. These large swaths of land in a few places within the U.S. make use of intensive agriculture consisting of artificial fertilizers, transgenic plants, mutagenic pesticides and herbicides to finally deliver food to our local markets via trucking all over the U.S. We can no longer rely on local farms to feed us because these specialize on a few organic crops and anyway their throughput is so low but even in spite of that, they, as well as local gardens have become target of our government to be regulated or even outlawed. Thus we’ve become so dependent on a few companies to bring us food from somewhere else and they could easily decide not to stock our grocery stores. By the same token, the telephone (cellphone/ fixed phone lines) and internet communication could be shut down by the flip of a switch.  The day you fight back, that day you won’t eat, won’t talk on the phone, won’t get online or take your asthma medication. And it doesn’t matter if you have guns, you won’t be able sustain a peaceful/less protest with your stomach empty. In summary, the quiet switch to Medco at the expense of our local pharmacies will likely mean Deadco. Please support your local pharmacy, support your local farms, support local businesses, get back your government.

    • Sorry, wrong link. Corrected below.

      As is already happening in the food, telephone and internet industries which are getting concentrated into a few hands, the people, patients, doctors and local pharmacies are gradually losing power.

  26. Whoever is paying attention to this topic (might just be me!), you’ll find instructive to watch several documentaries out there. “The future of Food” in one of them that truly lays out the concentration of our food into fewer hands represented by GMO-businesses, fertilizer, and agribusiness industries, and most interestingly the revolving door between private companies and government. It’s definitely worth watching. Another one and more scary is the freely available Nutricide (google videos) on a conference by Dr. Rima Laibow MD on the Codex Alimentarius. Really Orwellian.

  27. Medco sent me Vitamin C capsules instead of Effexor. It took me quite a while to realize it, and I went through hell with the withdrawal. It almost wrecked my marriage.

    I know that it was just somebody’s slip-up, not intentional. Even so, I would never use their services again, nor recommend them to anyone else.

  28. I’m conserned who is working at Medco and where do they get the medication from to put in their warehouses. When this company sends a wrong perscription to you not just once but twice and you call to inform them of the mistake WELL as they tried to say “it is not their mistake”? This company even goes to the extreme of telling you that the manufacture company changed the look of the pill. Funny thing is I had called the manufacture of my medication and there had not been any changes in the look of the pill nor had the color changed to the strange pills I received.I also call 3 local pharmacies and they also said nothing about the pills had changed. Medco is a piss poor excuse for a pharmacy. What happen to a persons choice in their mecical and perscription coverage? I have no trust in this Medco company and I hope that some how they are put out of buisness and it doesn’t take some one to loose their life before they are closed down.

  29. Pingback: Mail order pharmacy, part 1 at Dr. Leigh Saint-Louis

Leave A Reply