The Pharmacy Chick

Flying the coup in retail

Read.My.Directions….

Filed under: Uncategorized — pharmacychick at 10:45 pm on Thursday, May 28, 2009

I am fully aware that a Doctor’s office is a busy place.  I am also aware that I do everything in my power to make my communications with said offices as quick, efficient, and accurate as possible.  Therefore when this story unfolded, I was ready to beat my head against the wall.

A Rx came over the fax for Joan Smith for Actonel 150mg Once monthly.  Joan has an insurance that (for whatever reason) does not cover once-monthly biophosphates. The insurance rejection stated “Use formulary alternative: Fosamax or Actonel. ”

 I took the fax, and wrote the following on it: “Plan does not cover once-montly biophosphates, use Fosamax 70 or Actonel 35”, put my pharmacy info on the document and sent it back.  Four days and 3 phone calls later my store receives a fax for Joan:  Boniva 150mg once monthly….

Can you hear the sound of a forehead hitting the counter?

I couldn’t believe the fax.  What part of what I wrote was confusing?   Was there any ambiguity?  I didn’t think so.  Nevertheless,  we were back at square one. Again, I took the document, wrote the same thing on it and sent it back to the office. I also followed it up with a phone call.  Nurse called me back…twice…to confirm what I was asking.

Two days later I got a beautiful fax:  Actonel 35mg 1 q week.  Whoo Hoo!  I could hardly wait to get that script done.  Twenty seconds later it was transmitting to the insurance.

REJT: PRIOR AUTH REQUIRED.  What…The…Hell????  If my vascular system had an pressure valve someplace on it, there would have been a spout of blood flowing several feet high.  Ya know how a woman’s voice raises a few notches when she is agitated?  Thats about where I was when I dialed up the Insurance company, whose phone number I had memorized.  It was a local number.  Feel pity for Jake. He answered the phone.

“Feel Good Insurance Co,  Jake speaking”  “jakethisispharmacychickatpharmacychickpharmacyandIamatmywitsendifyoudontfixthisrightnowbecauseI amnotcallingthisdr’sofficeonemoretimeonthisstupidprescriptionsohelpmeGod! (breathe deep).  He heard me out, and while he said the processor’s response may not accurately reflect the proper formulary, (why not???)  he understood (by now) that he was dealing with a crazed pharmacist.  He took the information from me, and told me he would contact the Dr’s office himself and start the PA procedure.

All I can say is:  he had better. 

Nobody takes care of her customers like PC. I want to do this job well, and I do not look kindly upon being made a fool. When that prompt said “use Fosamax or Actonel”…I took it at its word. I owe it to my customers to be accurate and in my opinion, the PBM owes it to me to be accurate as well.

And so it goes. Another day in the life of a pharmacist. Thankfully Joan is a patient woman.  PC?  not so much by now.

5 Comments »

Comment by KCflacpht

May 29, 2009 @ 5:06 am

Oh, I am sooooo with you on this!

I especially love it when we send a fax with a note such as ” Patient A, Dob 1/01/XX, RX for ‘Drug X’ is not covered by/requires prior authorization by patient’s insurance ( and we ALWAYS include tele# to call insurance!). Please authorize or use formulary items drug Y or drug Z. KCpharm #100″

And they send back the fax:” Drug X, 5 refills”

*facepalm*

Like a patient needs MORE refills for a drug they can’t afford/won’t buy to begin with……

Comment by Dr. Grumpy

May 29, 2009 @ 6:07 am

Agree with you, PC. How frustrating. And I gotta commend you on going the extra mile for you customer.

That’s just stupidity on the part of the doc’s office. If the doc did that, he’s an idiot. But for all we know he has a trained chimp making these decisions.

I’m glad I’m in my tiny solo practice. All those faxes come directly to me, and I try to work them out one by one to make sure they get handled properly.

Comment by Pharmacist Erin

May 29, 2009 @ 7:39 am

Don’t you just love when the claim rejection isn’t the true rejection?! The other day I had a Medicaid rejection for Concerta for PA required. I KNEW it was covered and knew I’d have to make a phone call. Sure enough, the response was “Yeah, our PA system is down so it’s not a true PA required rejection.”

Here’s a lovely idea – how about putting a rejection message of “System down – retry later.” Brilliant!

Comment by RxMomma

May 29, 2009 @ 5:58 pm

yeah… PBM’s suck…. just another reason why you should switch out into hospital-land!!

Comment by PharmacyJim

May 31, 2009 @ 7:02 pm

There is a line in the movie “As Good as it Gets” that is used by Helen Hunt’s character to describe an insurance company/HMO. Not exactly the kind of language I would use…..but some days, I feel that way.

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