The Pharmacy Chick

Flying the coup in retail

Cash on the barrel head please…

Filed under: Uncategorized — pharmacychick at 6:36 pm on Friday, March 19, 2010

This Post name reminds me of a M*A*S*H episode where Radar asks Colonel Henry Blake to sign a bunch of forms, which he does obediently. After asking “what exactly am I signing?” Radar just says ” Oh, just  Requesting permission  to order  more Request  forms Sir..”

The Prior Auth process is a little like this M*A*S*H scene.  However the Pharmacy Chick’s customer was dealt a stealthy blow on Monday.

DrY prescribed for Patient X a tube of Tri-Luma, which we all know is basically a prescription cosmetic containing fluocinonide, tretinoin and a skin bleach.  It was no big surprise that it wasn’t covered by her insurance, but it left a small door open by saying “PA Required”.  My SOP is to fill out a form of my own design, filling in the blanks and faxing it to the office to start the PA procedure.

It wasn’t 5 minutes later that a rep from the office called us back.  ” We got your request for Prior Authorization and wanted to let you know we will not be doing it.  This is an asthestic medicine clinic. We do not take insurance and we do not do prior authorizations for clients.  She will have to pay or go without”. 

I wan’t mad.  In fact I was jealous.   I think this Dr found a way to make a living away from the oppressive thumb of insurance companies and live off the vanity of the masses.

I have already seen this trend in medicine.  Asthetic medicine, Cosmetic Dentistry,  Cosmetic Dermatology,  all making a living by finding a way to wiggle out of the insurance noose. 

I only know of two pharmacies ( in my area)  who dont take any insurance. One is in a pretty small community.  Run by one guy, he calls the shots and it appears that me makes a living, maybe not a zillion bucks but his overhead is low and his reasonble pricing keeps at least the cash payers happy.  The second is a compounding pharmacy.  Finding that crucial niche, they dont take insurance and compound specialty products for humans and animals alike.  I am not talking  your basic Salicylic acid in  aquaphor mix, I am talking SPECIALTY products, bioidentical hormones, thyroid compounds, LDN, rectal rockets for cancer patients and veterinary products.  She has a great business and I have sent a lot of people there for compounds I dont have the time or the supplies to make. 

I am all for it.  I for one am sick and tired of all the compensations I have to make for insurance.  They tell me everything I have to do but how I pee. Most of my recordkeeping and documentation is to placate insurance companies.  ENTIRE PROCEDURE BOOKS are sent by corporate dealing simply with insurance issues.  AND if they find one small anomaly, they take all their money back and laugh while they do it. 

 I once had an audit for 100 claims by one of our local  providers.  They  focused on this DAW-1 Claim I had for a MS contin patient every single month.  They had me pull over 3 years of hard copies and wanted to see if every single one of them had DAW-1 written on them.  It took me HOURS of labor to dig thru hard copies.. a colossal waste of my time.

They charged me back on one where the physician’s PA had signed it but we submitted the Physician’s name.  I hope they screw themselves sideways.

Another time I had a Medicare Audit where they demanded I produce the patients diabetic testing log to corroborate the dispensing record.  well, she kept a pretty good log but she said ” I don’t write ALL of them down”.  Medicare wanted their money back.  I think the company fought that one and won however.  WTF?  why should my reimbursment be tied to Mrs C writing down her tests?  The hard copy sig AND what I dispensed were in accorance with the days supply allowed. 

I see Walgreens is dumping Washington State medicaid for all new patients.  I’d do it for ALL of them frankly.  Im no fan of WAG’s but I’ll at least say “way to go” on this one.

We’ve already seen a lot of dr’s dump medicare.  With Obama’s plan starting to cement, I can see a lot of providers girding for it by moving from the Insurance sector to the Private Pay sector.

I think thats a solid move.

What is your opinion?


Comment by Jen

March 19, 2010 @ 8:52 pm

I think it’s sad that this is what businesses have to do to stay alive. I agree with the decision to pull medicare, but I don’t agree with obama making it that way. it’s not fair to medicare patients and it’s not fair to pharmacies/doctors to have to turn away profits. I hate charging the elderly citizens 38 dollars for their stupid lipitor and even more for their xalatan. it’s a shame.
And, I would say there is no reason for him/her to be on Lipitor, when there is lovastatin, simvastatin, pravastatin sitting on the shelf, cheaper than M&M’s. I am a firm believer that costs can be contained with cost conscious prescribing. Where is it written that only new drugs work? As far as insurance goes, i can’t blame any dr for dropping crappy payers. They have to make a living and its high time that somebody take a stand against these huge playground bullies.

Comment by Square Peg Guy

March 20, 2010 @ 8:22 pm

It’s a lot to wish for, but I’m hoping that insurance companies will have to re-incorporate as non-profits. Either that or they must fall under strict regulatory policy, like electric utilities are now.

And I get insurance coverage through my employer!
Well if Obama gets his nationalized health care, that is exactly what it will be..a nationalized non-profit.

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