By Steve Ariens, PD Almost daily an email shows up in my inbox and/or I get a text or a phone call about a patient not being able to get their medication filled at the pharmacy. Sometimes, I have to defend the action of the Pharmacist. A recent email exchange was because the Pharmacist claimed…
What to do About Denial of Care at the Pharmacy Counter
Steve Ariens

Steve Ariens, PD

By Steve Ariens, PD

Almost daily an email shows up in my inbox and/or I get a text or a phone call about a patient not being able to get their medication filled at the pharmacy.

Sometimes, I have to defend the action of the Pharmacist. A recent email exchange was because the Pharmacist claimed that the refill was too soon.  It would seem that directions that the doctor put on the prescription read 1 tab three times daily and as directed and prescribed a quantity of 90 tablets. However, the doctor told the patient verbally that he could take 1 tab FOUR TIMES DAILY, if he needed to.

When it comes to calculating the “days” supply that is submitted to the insurance for billing purposes, the term “as directed” is MEANINGLESS in calculating the actual supply of how long the medication should last. So when the patient returned in 25 days for a refill-having taken 3.5 – 4 tablets every day-He was EARLY and denied his medically necessary medication because he followed the verbal instructions from his physician which did not technically match up with directions he had placed on the paper prescription.

The Pharmacist could have been in “hot water” if audited by the insurance company and/or DEA for too many “early refills”, because the auditors would look at the three times a day and disregard the “and as directed” as meaning that the patient could take more than three doses/day.

Then there was the email about a patient with a prescription for 31 days supply, to cover a month with 31 days. The patient was told by the Pharmacist that his insurance company would not pay for a 31 day supply and that they would not pay for a refill until 30 days had elapsed since the last refill date.

Under such circumstances, the patient should ask the Pharmacist for a screen print from the computer of the insurance company’s rejections. If they claim that they are unable to do that, simply offer them your smart phone to take a picture of the computer screen with the rejection information. If the Pharmacist claims that it is against company policy to do either, that is not a big problem.

Simply go home and call your insurance company, they will have record of the claim submission and if it was rejected and how many days early they will authorize the payment of a refill.  Under these circumstances, normally what the patient will be told is that the insurance company authorized the payment for the refill..BUT.. The pharmacy REVERSED the claim and then the Pharmacist told the patient that it was rejected by the insurance company.  Conclusion is that the Pharmacist LIED TO THE PATIENT.

Currently, I am recommending that patients do a audio/video recording of their interactions with the pharmacy staff.  I can’t count the examples given to me by patients of pharmacy staff developing amnesia of what was said or done or what was not said or not done. Experience suggests that corporate HQ will take the word of the staff over that of the customer.

There are only 12 states that have two-party recording laws and these laws were written when land-lines were the order of the day and they reference “private conversation”. IMO, it is hard to define the area at the pharmacy cash register as representing a “private conversation”. If the pharmacy staff objects to you doing a recording, just point to the store’s cameras that are recording you at the check-out.

The customers may not always be right… but.. customers always have RIGHTS !

Steve Ariens is a pharmacy advocate, blogger, and National Public Relations Director for The Pharmacy Alliance.

Source Nationalpainreport.com

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