PHARMACIST STEVE

There is at least one good thing about entitlements.. like Medicare… unlike private health insurance… they can’t raise your premiums at will.. nor decide that they are not going to insure you anymore.

Our Part D provider (PDP) is part of one of the major chain pharmacies – name with THREE LETTERS whose corporate motto is “where health is EVERYTHING”

Earlier this week, I entered in our pharmacy website three refills for Barb. Rather quickly I get THREE TEXT… one saying one of the Rxs are ready and one saying that one was two days early and one was four days early… all three of these Rxs were filled abt the same time 30 days ago..

So to make sure that I did not “go after” the wrong entity, I called the PDP and asked if they had rejected the Rxs or the pharmacy did.. come to find out..the PDP had declined authorization.

I asked the PDP representative what was their parameters for “early refills”… SEVEN DAYS… I did not have the specific last date they were filled and both were LESS THAN SEVEN DAYS EARLY… the representative stated that those two were CONTROLLED MEDS and that those meds had a TWO DAY early parameter.

So I pulled out the “DISCRIMINATION CARD”… and the reps response was “that is the law”… so I requested a copy of “the law” and or the FED statue number so that I could look up “THE LAW”…  phone line went VERY QUIET ..  long story.. short.. could not produce anything..

I pointed out that one of the medications was so INEXPENSIVE that the PDP paid NOTHING… my charge/co-pay was the TOTAL COST OF THE RX…  The rep’s explanation was that the discounted from normal cash price was WHAT THEY PAID..

Everyone and their brother ( HHS, CMS, PBM, Medicare, Medicaid, Insurance companies) are doing everything that they can to encourage people being compliant with their medication.. saves the system money.. but they don’t have any problem with me having to make THREE TRIPS to the pharmacy to help keep my wife compliant with her medication..  Long story … short… I got no where with them..

So I pickup the phone and called www.cms.gov (800-medicare) and filed a complaint that their policies were DISCOURAGING compliance.. the CMS has a STAR RATING SYSTEM.. that enough complaints… the monies that PDP, pharmacies, prescribers can get their rating dinged which means that the amount that they get paid – across the board – will get dinged as their Star Rating declines..

CMS does not deal with ADA violation/discrimination … but.. referred me to OIG/HHS (office inspector general/health & human services 800-447-8477).. so if filed a complaint that because this PDP is having different refill policies on certain classes of medication.. mostly taken by people who are disabled.

My complaint included that a TWO DAY early refill does not give any latitude to Mother Nature throwing a area a “curve ball”.. not to mention that when those who are disabled are having one or more a “bad days”… do you really want them out on the road attempting to drive to the pharmacy to pick up their meds.. or would you rather have them just being non-compliant with their medications and suffer the consequences of not having their meds… not  to ignore the fact that they might end up hospitalized along with the cost of a ride in an expensive ambulance.

Like I stated before.. what can the PDP do to me… they can’t drop me.. they can’t raise my premiums – rates are published and determined by state.. If CMS/HHS has guidelines/goals to promote healthy Medicare folks.. and the entities are not following/adhering to those guidelines… then unless they receive complaints about how those health care providers are failing those guidelines..  how can you expect the bureaucrats to take action.  If these bureaucrats fail to take action against those who are failing those guidelines.. then I will take my issues to my Representative & Senators… to point out how they are providing money/budgets for agencies that are not using those funds wisely..

Filed under: General Problems