DRUG NOT COVERED; STEP-THERAPY/PA REQUIRED. CALL 1-800-JACKOFFSeriously, that simple string of words is enough for this normally calm little pharmacy student to erupt in a fury of rage reminiscent of taking a cake away from a fat kid.
What makes it worse is that it happens when you least expect it, eerily similar to a herpes outbreak. Kind of like when someone brought in a new prescription today for loratadine.
"But Phathead," you're saying, "The smidgen of glue that holds the label on the bottle costs more than the number of tablets in the bottle. Never in a million years would a PBM require a PA on it."
Well that would be true... if PBMs were run by human beings with a lick of logic.
This particular plan, cough Medco cough, decided that cetirizine needed to be first line and that, for some god forsaken reason, loratadine would only be paid for after a PA and step-therapy.
Way to go Medco, you just saved yourself a whopping two cents by denying the initial fill. Glory be to you for such a wise financial decision which will ultimately bring troves of riches to your CEO. And by troves, I mean one or two extra Tootise Rolls after lunch.
Long time readers may remember that I have a particular hatred for the sadists that call themselves Medco. If anyone deserves to have bamboo shoots shoved up their urethrae and then forced to watch Glee for 24 hours straight, these guys are the unanimous winners.
After the pharmacist stopped laughing at the ridiculousness of the rejection, we kindly pointed her to the allergy aisle and told her it would only be a few dollars more to bypass this lunacy and receive the same treatment. She agreed, the gray skies parted and for a brief while peace and tranquility returned to the pharmacy.
Until the next PA rejection. About two minutes later.
Damnit.
3 comments:
Sheesh - nobody should prescribe cetirizine, loradatine, or fexofenadine as they're all OTC, and the first two have store brands available....
Stupid humana would not cover an rx for terazosin 2mg recently for a patient because about 5 days prior he got an rx for terazosin 5mg. They required a pa. I called and told them he was no longer taking the 5mg, went to the er with dizziness and that is why he is now on the 2mg and said they needed the dr to call to get override. I told them the er was not going to do it and when they asked if his primary could I hung up on them. Valid PA's I can understand, but for christ's sake you are wasting everyones time with dumb pa's.
Oh, yay. My two favorite letters in the English language these days. "P.A."
And then the customer calls every day starting the day after you send the request to their doctor (if not mere HOURS later) wondering why they can't get their meds paid for by insurance. And then there's always the happy "But I have a PRESCRIPTION!" response and trying to explain to the poor bastard why their insurance company is second-guessing their PCP. Bah!
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