Until about 3pm.
You see I got a refill auth on some pen needles for one of our elderly diabetics. Brought up the previous fill and noted the last fill date (patient was on Day 22 of 25. Remember that). Started processing through his insurance... and then hit a rejection.
No big deal, flip to the screen and low and behold I see this.
Refill too soon.. Next refill date 7.14.09... days left 13... last filled 6/9/09
Huh?
I'm doing the math again and 25 days after 6/9/09 is 7/4/09 correct?
Puzzled I call Medco to see if this was a glitch on their end. I started talking to a chipper, but obviously dense, young lady.
She starts rattling off that the patient should have another 10 day supplies and yada yada yada. I ask her how she would know how many he should left.
She then goes, well he had it filled five days early two fills ago, two days early one fill ago and three days early today.
I then ask her, in much more polite language, just how the fuck that has to do with anything.
She replied, and wait for it
We only pay on exactly the day it is to be filled, not sooner
Literally I have to fill this on Day 25 of 25.
I ask her what we are supposed to do if the patient misplaces a tablet or two or we happen to not be open that day. The woman says she's sorry, but it cannot be filled any earlier than that day.
And they will not do an override.
AND this applies to ALL classes of prescriptions, not just pen needles.
So Medco has decided that every single one of their insurees must now pick up their meds on exactly the day they are due to be refilled. No filling early by any means for any reason.
How fucking illogical is that? Of all the penny-pinching unethical things to fucking do. I informed my manager who decided we need to go do some ass kicking at Medco.
Just who the fuck do they think they are dictating something like this?
The scary thing is, this policy had been in place for over two months. No one had decided to notify the patients or the pharmacies. I just happened to stumble upon it today by a stroke of luck. And some fucking stroke that was...
Thus Medco, you can go fuck off.
And for all you other pharmacy minions out there, hopefully I have enlightened you with a tidbit of knowledge you weren't familiar with. At least you may not be caught as off guard as I was.
8 comments:
I ran into this a few months ago with a customer on phenytoin. I think I spent 30 minutes on the phone ranting and raving with supervisor after supervisor until they did an override. Scary that the guy could've been without phenytoin for several days. I've never hated an insurance company so much in my life.
Lately, whenever I process through Medco I get a reject message of "Prior auth required", so fill out the paperwork send to the doctor, etc., only to get a phone call back saying, "that medication doesn't need a prior auth, its a refill too soon" what?? Since when does refill too soon = prior auth?
Medco is a bunch of filthy sons-of-bitches. I wish they'd overdose on APAP in a place where they can't get acetylcysteine.
Think thats bad, they bill self-insured plans up to 5 times what they pay the pharmacy on generics, they were billing the plan over 180 dollars for 90 simvastatin 20, but paying the pharmacy 30 dollars. (and it was a government plan...)
Another thing is they don't always notify people when their insurance ends but still pay. When they send the collection letter to the customer we back-bill the correct insurance and repay Medco through corporate which can take 2 to 3 months. But in the meantime Medco sends the bill to a collection agency, so the customer gets angry calls. So Medco eventually gets repaid but they NEVER notify the collection agency that they were paid. The person from corporate said it can take years to get it straightened out.
After several, several, SEVERAL problems with Medco I reached my wits end today. I called to refill a med for my husband. prior auth. required. I jump through those hoops, that is done and I call in the refill that has been authorized. I have to pay 100% of the drug cost until my deductible is reached so the cost will be $137 for 90 day supply. Hmmm... I call a local pharmacy and same drug, same strength will be less than $20 for 30 day supply (both generic). So I call Medco and ask why. This woman who is not fluent in English tells me "That is the cost with your plan". I tell her to tell me why or transfer me to someone who can. Someone else comes on after a lengthy hold and tells me that this is the contract price with my plan and it will be applied toward my deductible, and if I choose to go to my local pharmacy and pay less than 44% of Medco's cost it will not be applied toward my deductible. The choice is mine. Seriously? I told the girl that it doesn't matter what a policy says, we learn in kindergarten right from wrong and this is wrong, yadda yadda... I'm sure my morality check had a huge impact on her and the company... So for me, as long as I can possibly afford it, I will use my locally owned pharmacy where they are nice to my kids and give them little grab bags filled with candy and toys for Easter and pay cash that will not be applied to my deductible to buy my meds. This is what I will pay for my principals, with Medco seeing not one dime from me.
Worked at Medco 10 years. It's prescription filling policies are unsafe and must be challenged. Read more. See view. www.ihungerstrike.blogspot.com
Raj Bhat RPh
Tampa FL
I've encountered this with Medco and a few other processors as well. What they determine is that if someone is at least 5 days early on their meds on a consistent basis, they basically decide that after a while they will not pay until the patient "catches" up to their original day supply. It's silly, but most won't budge on it unless you really harrass them.
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