Has WellCare Put Profits Before Patients?

By Michael Wong, JD (Founder & Executive Director, Physician-Patient Alliance for Health & Safety) 

This is the question that I recently asked myself – “Has WellCare Put Profits Before Patients?”

In a letter to Ken Yamaguchi, MD, MBA (Executive Vice President, Chief Medical Officer WellCare Prescription Insurance, Inc.), the Partnership to Advance Cardiovascular Health (together with a coalition of concerned organizations, including the Physician-Patient Alliance for Health & Safety) ask Dr. Yamaguchi about a pricing decision WellCare made for seniors that will increase the price of a drug by five times what they had previously paid:

recent formulary change that will drastically increase the price of apixaban for Medicare Part D WellCare participants. By placing apixaban on a higher formulary tier, medically fragile seniors will pay five times as much for their life-saving direct oral anticoagulant (DOAC).

WellCare letter from PACH

Are Patients the “Reason for Being” for WellCare?

The motto for Wellcare is:

Our members are our reason for being. We help those eligible for government-sponsored health care plans live better, healthier lives.

The members of WellCare are presumably patients who are members of their healthcare plans – or is it someone else?

In a recent survey, the National Partnership for Healthcare and Hospice Innovation found that 82% of Americans believe the US healthcare system puts profits ahead of people.

Is WellCare putting profits ahead of people?

The WellCare Decision – Yet Another Formulary Exclusion

My other thought, when I agreed that the Physician-Patient Alliance for Health & Safety would sign the letter, was – here we go again!

At the beginning of 2022, CVS Caremark also made a formulary exclusion:

Beginning in 2022, CVS Caremark (part of CVS Health) has excluded Eliquis® (apixaban) from the CVS Caremark Preferred Drug List. Eliquis is “indicated to reduce the risk of stroke and systemic embolism in patients with NVAF. Eliquis is indicated for the treatment of DVT [deep vein thrombosis] and PE [pulmonary embolism], and to reduce the risk of recurrent DVT and PE following initial therapy.” Eliquis is a Factor Xa inhibitor and is a Direct Oral Anticoagulant (DOAC). 

In the case of CVS Caremark, their decision impacted the lives of many patients, including Beth Waldron. In a David vs. Goliath-like battle, Beth Waldron won. Moreover, it was a skirmish that saw a possible HIPAA violation.

Eventually, CVS Caremark reversed its decision saying that this came after negotiating a lower net price with the drug manufacturer.

WellCare Should Put Patients Before Profits 

“The Customer is Always Right”

This famous slogan was popularized by pioneering and successful retailers such as Harry Gordon Selfridge, John Wanamaker, and Marshall Field.

Putting the customer first is just good for business: 

It is difficult not to roll your eyes when you hear executives talk about “putting their customers first,” especially when their businesses behave like their customers are more of a burden than a blessing. Interestingly, companies that truly do put their customers first continue to benefit from an advantage that their competitors’ lip service fails to erode.

So, WellCare, please do the right thing – put the patient before profits. And, if you won’t listen to this small nonprofit, take a cue from CVS Caremark and reverse your formulary decision.

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