Wednesday, September 15, 2010

E-prescribing idiocy

I bitch about it. The Angry Pharmacist bitches about it. This is nothing new.


But yesterday afternoon I discovered a whole new reason to hate e-prescribing.


I have a lady who takes Fukitol 3mg, four times a day.

Fukitol only comes in 1mg pills. So she takes 3 pills, four times a day.

So 12 pills each day. OR 360 pills in 30 days.

HOWEVER, her insurance requires her to use Lostinthe Mail-Order pharmacy.

Like most mail-order pharmacies, this one only sends out 90 day pill supplies at a time.

So Mrs. Patient asked me to send it by e-script to Lostinthe Mail pharmacy.

12 pills x 90 days is 1080 pills. So I just transmit a script for 1080 pills.

Sounds easy, huh?

The online thing rejected the script, on the grounds that it won't allow pill supplies of more than 999 pills at a time.

I tried submitting it for 2 scripts of 540 pills each. It wouldn't allow 2 scripts of the exact same thing.

So I submitted it for 999 pills for 90 days, and figured Annie would just tell the patient the reason for this, and we could make up the difference with samples.

Of course, the online e-script program rejected this, too, and pointed out that a 90 supply for the patient is 1080 pills. It even asked me to resubmit it for that amount.

Which I did. And it was promptly rejected for being > 999 pills.

Catch-22.

I mailed a written script for 1080 pills to the patient and told her to send it to them. And scream.

26 comments:

Julie said...

grrrrrrrrr ... i had a day like that yesterday ....

Jackie said...

gack that is awful!!! We're still in the dark ages when it comes to 'scripts but i'm not sure which is worse!!

xx
Jaxs

GlassHospital said...

I love Fukitol. I usually take that along with Geritol after my bran in the morning. Sometimes i dissolve it in my coffee.

Anonymous said...

I was taking a pill a day. $6.00 a month.My insurence co sent me a letter asking if I would like to get it thru the mail for 3 mo. at a time. I said no. The next time I went to pick up the med they said it cost $39 a montth now..I asked why the change in price. They called and were told I coud still have it for $6 a month if I used the mail order form and bought it for 3 months at a time.But as long as I picked it up monthly at my store it would be $39.

Karen Henry said...

Welcome to the insane world of insurance and prescriptions. You wouldn't believe how often you can get a (cash price) $9 prescription at local pharmacy and mail order will send it to you for $30 for a 3 month supply. Bargains, people! And guess who they call when they have questions?

I so love the rationale that you bumped up against - yup, catch-22. all. the. time. So sorry you get to deal with this! Hope it helps knowing we hate it as bad as you do...

karen, rph

Charlene H. said...

The uphill battle of logic vs. insurance companies will never be won. When I was on birth control, the BCP pack was 28 days. 28 x 12 ( a so-called "year" because each pack was a month's supply )= 336 days. They would not let my doc write a script for more than a 12-cycle "year," and would not let me get a new exam for script until exactly a year had passed. I guess I was supposed to get pregnant the other 19.25 days a year.

Amy said...

I take birth control pills continuously, skipping the placebos, and even when my doctor writes that directly into the prescription, it's a nightmare to get the insurance company to do the refills. I go into the pharmacy when I'm about to run out of pills, but the insurance company thinks it's too early because I still have the placebos (which I'm not supposed to take), and they won't pay for the refills. The hassle became so great that now I just pay for every 4th package out of pocket to avoid the problem. I guess that means the insurance company won.

Anonymous said...

Amy, if it is written into the Rx (as you say), have the pharmacy enter it as a 21-day supply (which they already should have done!). This will allow the Rx to be refilled every 21 days rather than 28. Since each pack should only last 21 days, thats how they need to enter it, rather than 28. If this is an insurance mandate (many insurances are jerks about birth controls) that they always be 28 day supplies, then they can't do that, and this won't help. Good luck!

Anonymous said...

Anonymous --

The pharmacy COULD do what you say and it could work. BUT, it is a major red flag to the insurance and will almost always trigger an audit.... which the pharmacy will avoid like the plague. It's 28 pills, one a day, it's a 28 day supply. The pharmacy will be correct on the billing for this ONE patient's prescription (since, once the hard copy is pulled by the insurance nazi, er, I mean auditor, it will show the correct directions and it is supposed to be a 21 day supply), BUT how many other pissy things will the insurance nazi (er, auditor) find that they will reject the claims for?

Not unheard of for an independent pharmacy filling 400+ scripts a day to have one of these audits happen and the insurance company wanting TENS of THOUSANDS of dollars back. If I were the owner, I would send it through for a 28 day supply.

The Mother said...

Lovely.

We tried the mail order, 90 day thing. After my son's shrink changed his script 3 times in 3 months, we stopped.

Plus, they never had what I needed. The largest mail order pharmacy in the southwest, and they never had what I could get around the corner at Walgreens.

Anonymous said...

I love e-prescribing. I don't have to decipher prescriber's handwriting. Any problems is automatically the vendor's fault and not the pharmacy's. How can I not love that?

I also love mail-order pharmacy. They "help" my patients appreciate my services. Besides, they fill my wife's prenatal just fine.

PharmGamerKid said...

don't forget the prior auth insurance companies make you guys do for the lamest stuff (i.e. taking diflucan for 3 days vs. 1 day and pt is supposed to start like NOW but PA will take at least 2- 3 days)

Old MD Girl said...

Gabapentin?

Wick E. Scratch said...

Too bad the patient didn't have the phone number to call in the prescription ... even easier than e-scribing, and probably less time consuming, Lolz!

Regarding some of the negative points made regarding insurance companies, one thing to clarify is that insurance companies don't mandate someone to use mail order pharmacies - it is the company that you are employed by (or the plan you chose) that requires it. The insurance company is just doing what was bought ...

On the negative side, I'm not big into mandating anything regarding a patient's choice of doctor or pharmacy.

On the plus side, it surely contributes to me being employed...

One suggestion with the e-scribe (depending on how the particular mail order pharmacy handles increasing the quantity of a 30 day supply to a 90 day supply) would be to write it for a 30 day supply (so that it would go through) with PRN refills (if you want it for a year), noting on the prescription somehow that you wrote for a 30 d/s because the program wouldn't allow a 90 d/s qty ... Just a thought ...

Anonymous said...

I don't understand why/how we docs (and pharmacists) ever let ourselves get into situations like these in the first place. Why did we ever agree to be the go-betweens for insurance cos and patients? Pts need precerts/scripts/our services reimbursed, let them do the paperwork. What does filing forms, etc have to do with pt care? It's a huge waste of our professional time, not to mention the office help we have to hire to deal with all this - that we don't get reimbursed for. Hey, that's an idea! Maybe they can offer insurance to docs to deal with insurance cos.

Anonymous said...

Anon 12:40- I completely agree that it would send a bright red flag to the insurance nazis that audit us, and I personally know the pain of them going through your records, and how much they rip us off that way (been there, done that!). However, if properly written NOT to take the placebos, isn't it misbranding, and altering the Rx, to call it a 28-day supply? And if that causes the patient to pay out of pocket, the patient has every right to argue! I just couldn't call a it 28 day supply to avoid the insurance audit. It all comes back the insurance companies ripping both the customers AND the pharmacies.
Also, after interning at "Big Monopoly Insurance Co" for a month, I learned that Wick is exactly right, businesses get bargain basement plans for their employees, plans requiring mail-order use, rather than buy better plans for their employees.

Anonymous said...

Writing "PRN" refills in my state isn't valid anymore, it automatically becomes a big, fat zero.

The Angry Pharmacist said...

"Regarding some of the negative points made regarding insurance companies, one thing to clarify is that insurance companies don't mandate someone to use mail order pharmacies"

Uh, I call baloney. Medco mandates their mail order pharmacies after 3 retail fillings and only allows us to fill the piddly shit like antibiotics. We only keep our contract with Merck/Medco because I dont have the heart to have my patients brave WalMart when they (or their children) have a sinus infection. This is with ALL of our Medco patients from all different businesses.

And how did we get ourselves into this situation? Its a combination of Pharmacists/Doctors caring about patients (unlike other businesses that care about profit) and the uncanny ability of Americans to want the world at no cost to them.

Whoever foots the bill calls the shots, and the only plastic insurance card that lets you 100% call the shots has VISA or MASTERCARD printed on it.

Mad Pharmacy Tech said...

All in all, like anything else in this country, there are upsides to e-prescribing and downsides. The good part is as a tech, I can actually read what is being prescribed. The bad part is sometimes it still doesn't always make sense.

As for insurances, anyone who's worked in a pharmacy or any other medical office knows how much of a hassle they can be all the way around. I have hung up on many of them because they just didn't want to help, or because "Amanda's" accent was just too difficult to understand.

Teflon Dad said...

And soon e-prescibing will be required of all for all. And this scenario will be Dr. Grumpy's fault and make him subject to penalties (fines) when he gives a written script.

vicki said...

and what will the health care bill say about rx's?
i take venlaflaxine and they said i had to get a 90 day supply not 30 day and pharmacy had to fax doc to get 90 day script instead of 30 day
they are trying to do that on all regularly prescribed meds to cut down on 30-day refills and have more 90-day ... saves time and $$ and more long term profit

Wick E. Scratch said...

TAP,

I see your point on that specific part of what I said - but the main part of my argument was the part immediately after. Which ties in to your statement that whoever foots the bill calls the shots.

The overall point I was trying to make is that the insurance company is only doing what the employer requested/purchased.

If Medco mandates the use of their MOP's, that is their business.

But, XYZ corporation is not required to choose Medco for employee benefits. There are many other insurance companies to choose from.

I would posit that if XYZ Corporation was large enough, they could tell Medco "suck it", and tell Medco that they either remove the requirement to use their mail order pharmacy, or they will take their business elsewhere.

The unfortunate thing though is that XYZ corporation would have to be pretty damn big to be able to do that ...

Perhaps even more effective would be if unhappy patients went to their HR department and expressed concern (complained) about the deal.

Anonymous said...

Senator Lieberman's constituent, I'm-not-so-glad-I-met-ya's mail order pharmacy charges a ludicrous copay for a 90 day fill of a generic ($37.50). I have scripts at 3-4 local pharmacies, where I pay less and don't have to wait 2 weeks. (And no, I don't go to Walmart/greens)

Anonymous said...

"Uh, I call baloney. Medco mandates their mail order pharmacies after 3 retail fillings and only allows us to fill the piddly shit like antibiotics. (...) This is with ALL of our Medco patients from all different businesses."

Medco does not mandate it. Plans may choose to buy the retail fill limit, but it's not a requirement, and many that do opt for it customize the # of fills, the price after the fill limit is reached, meds that qualify for the limit, etc. Many many plans don't carry this limit at all. In a retail setting of any size, it would be extremely unusual to have only encountered plans with retail fill limits. Any retail staff wondering if a specific plan has that limit can call the help desk and ask. Whatever the plan wants to pay for, Medco will make happen. The same is true of any PBM that wants to keep its contracts.

Back to topic, I sure hope the good Dr Grumpy filed a complaint with the escript software provider regarding the problem he encountered. The more complaints they get about it, the more likely it will be fixed in the next release.

Red Urine said...

This blog is probably the most-commented and well-thought out comments of any medical blog I have yet to see! wow - great community!

Loren Pechtel said...

Yeah, they can be pretty stupid. I send in a script and somewhere along the line it acquires an extra zero on the quantity. The first time I get a box with the correct quantity and a slip saying the rest were backordered. The second fill works fine. The third doesn't show--so I call about it, figuring it went astray in transit (they never required a signature despite it being pricey and they routinely used too light a box.) but the actual problem turned out to be that errant zero--the quantity was in excess of a three month's supply so they simply didn't fill it. They didn't call or anything, though!

 
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