This showed up in my inbox… from this three day story.. it would appear that this particular pharmacy made a days supply input error and it resulted in the insurance denying payment when the pt presented a new -on time – Rx to continue their therapy.. the pharmacy staff apparently discovered and admitted their billing error and apparently REFUSED TO CORRECT THEIR ERROR. It is very difficult to make a Methadone to Morphine conversion but 50 mg/day of Methadone would be in the ballpark of 250 mg of Morphine per day. One can only imagine the severity of the withdrawal that this person is going to do thru.. not to mention the severity of untreated pain. If harm is caused to pt by a pharmacy by misfilling a Rx.. that is a accident and still could result in financial restitution to “make the pt whole”… what could the damage be if this pt is harmed by the INTENTIONAL ACT of refusing to correct a medication error. If you are reading this and you are a personal injury attorney.. I have this person’s contact information.. contact me.. I will make the introduction…
I know you speak with a lot of people & may not remember me but you gave me some good tips / advice a few weeks ago.
Now I have yet another question for you. This time, I cannot see how the pharmacy could get away with this & would love your input.
I’ve been using the same pharmacy since my accident (over 2 years ago). Because they knew me, always had my prescription in stock (even if I had to wait one / two days) and I felt comfortable there; not treated like an addict.
As of January 1, 2015 That pharmacy (The Pharmacy at A Hospital) put new rules in place.
1. You must live within a 5 mile radius of the hospital
2. Must have Health Insurance (cannot self pay)
3. The prescribing doctor must be affiliated with the Hospital
I had 2 of the 3 regulations. My Doctor had recently stopped practicing at Memorial.
So I switched to a PM Physician who was affiliated.
My first visit with said Doc was good. I like him. We have a plan for treatment. He wrote me a 2 week prescription (14 days) – I was to take 50 mgs a day & was given 70 (10mg) tablets . 5 a day.
Today was my 2nd visit, he did some injection treatment & wrote me a prescription for 28 days at 60 mgs a day- (the 50mgs a day was not quite getting me through a 24 hour period).
So I take my script to the Pharmacy & was told it couldn’t be filled because my Insurance would not accept until after 02/16/15. Another 7 days – Why? Because their records showed the last RX filled was for a 24 days supply.
After speaking with my Insurance Company to find out why they would think such a thing I was told that someone at the pharmacy enter the information which stated it was a 24 day supply – Which it was not.
I called the pharmacy & the technician helping me could see the scanned copy of the RX which clearly read 14 day supply. But someone entered the number wrong (A TYPO) & put in 24 day supply.
Still as of this moment, the pharmacy is saying it will have to wait until 02/17/15.
Even after admitting to me that it was their error. The supply date entered was incorrect.
I asked them to correct the problem so the insurance will cover it –
They closed before I could call them again.
If they do not make their mistake right, what is my coarse of action?
I am in absolute disbelief. After jumping through hoops for over a month & doing every thing they told me was needed to fill my RX without hassel, It seems to me that they are in the wrong.
BIGTIME!!!
If they entered the wrong info & I cannot access my medically necessary medicine aren’t they liable in some way. ???
I am so so angry, in tears & don’t know what else to do. I can’t seem to just survive.
02/13/2015
So today is the day I am officially out of my pain medication (methadone 60 mgs per day).
My PM Doctor was faxed a form from my Ins. Co. to fill out & state that it is Medically Necessary for me to take this medication / dose / strength / Diagnosis. He filled it out & faxed it back Wednesday (02/11/15). Yesterday they advised me that it would take 48 – 72 hours for the pre-authorization to be reviewed & approved. That’s if he stressed the urgency of the situation.
Then I asked for an “early refill override” – apparently that take 3 – 5 business days, so no point.
Basically If I had known the pharmacy intentionally entered it as a 24 day supply instead of a 14 day supply, I could’ve had all documentation in place by now. I wouldn’t be out of pain medicine.
I just wonder what excuse they will dream up next month.
I don’t understand why it matters to them / why is it so important for so many pharmacist to deny the medication.
There are safe guards in place. They can tell that I only see one doctor & do not get various pain medicines prescribed to me.
They could even see that I’ve cut my dose by 30 mgs in less than 2 months. I am obviously not a criminal or abusing the prescriptions.
I’m in for one hell of a weekend.
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This showed up in my inbox… from this three day story.. it would appear that this particular pharmacy made a days supply input error and it resulted in the insurance denying payment when the pt presented a new -on time – Rx to continue their therapy.. the pharmacy staff apparently discovered and admitted their billing error and apparently REFUSED TO CORRECT THEIR ERROR. It is very difficult to make a Methadone to Morphine conversion but 50 mg/day of Methadone would be in the ballpark of 250 mg of Morphine per day. One can only imagine the severity of the withdrawal that this person is going to do thru.. not to mention the severity of untreated pain. If harm is caused to pt by a pharmacy by misfilling a Rx.. that is a accident and still could result in financial restitution to “make the pt whole”… what could the damage be if this pt is harmed by the INTENTIONAL ACT of refusing to correct a medication error. If you are reading this and you are a personal injury attorney.. I have this person’s contact information.. contact me.. I will make the introduction…
[…] https://www.pharmaciststeve.com/?p=9167 […]
Days supply is NOT complicated. Topicals like creams I give a standard 7 days and eye drops will depend on use (antibitotics 10 days, glaucoma 30 days..however for eye drops 20 drops=1ml, but when they write for 15ml bottle, I just put 30 days and insurance accepts no problem) If the pharmacist was worth anything…he/she should have called the insurance and notified them of the days supply error. A reversal could have been done by the pharmacy with theim on the phone looking at the fill and the claim resubmitted with the correct days supply. Ive done it several times and I’ve even done it without talking to the insurance…I just reversed the claim and resubmitted with the right info. IT”S NOT ROCKET SCIENCE. If the pharmacy told you an emergency refill override would take 3-5 days…that’s BS…it’s takes all of how long it takes to call the insurance and talk to a live person on the phone…even the the reason would have been for the wrong day supply and gee, they could have fixed at that point also. Talk about a power trip…..I’d be filing a complaint with the administrator or the hospital’s patient advocate.
Days Supply issues can be complicated to correct. I am trying to figure out how I could fix your problem. I would try, but I can imagine that the software might blow up.
I truly feel for you and know exactly what you are going thru bc my husband and I both go thru this on a monthly basis…but your situation is unforgivable!! I would sue the hell out of the pharmacy that has made this huge error! We have got to stand up for ourselves before we as US citizens loose all of our medical rights in this country. Its sad to say but I feel we are becoming a combunist country.