http://www.wbjournal.com/article/20140708/METROWEST01/140709966
From the article:
In fact,(CVS Caremark) terminates less than one percent of its network pharmacies in a year. We pride ourselves on maintaining the highest standards for safety and quality for pharmacies in the network and a necessary component of this is ensuring that pharmacies are complying with the terms of its provider agreements,” Castel wrote.
what happens when “profession discretion” is in conflict with CONTRACT COMPLIANCE ?
Because contract compliance is normally determined “after the fact”.. how many pt complaints about not having their Rxs filled will it take to cause a full blown audit.. and you know how those audits goes.. they find all sorts of “i’s” you forgot to dot and “t’s” you forgot to cross.. and all those ZEROS on the demand letter for refunding monies?
Could your “professional discretion” be the next “big thing” for the PBM’s come back on you on.. you know every year.. they find a new “wrinkle” in a audit that they have never looked before.. What you consider a “questionable Rx” will they not agree and come to the conclusion that you violated the contract by a refusal to fill rather than a decline to fill because of a valid medication contraindication ?
How many other patients with a chronic disease.. do you just refuse to fill and not try to resolve the issue and make sure that the patient leaves with some sort of appropriate therapy.
Filed under: General Problems
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