Don’t necessarily believe what they say !

I am reading more and more about Pharmacists telling pts that their insurance company will not pay for their meds today but in a couple of days.. when the pt knows that they are within their prescribed dosing.

If the Pharmacist is telling you this.. then he/she has submitted the claim and has a DENIED statement on the Rx computer screen.

To validate what you are being told.. ask the Pharmacist to do a computer screen print of  the rejected claim.. then you see for yourself how many days your insurance company states that you have to wait..

If the Pharmacist claims that he/she can’t do a computer screen print.. ask them to let you see the screen with the rejected displayed on it.. take a picture of the screen with your smart phone… if you can…

Denial of letting you see the screen and/or not able to print the computer screen.. chances are . .. Pharmacist never submitted the claim and not being truthful with you. Note the date/time and the name/initials of the Pharmacist you have had the interaction with..

Go home, call the customer service of your insurance company.. you will find a 800 number on the back of your “drug card”… a representative of your insurance company should be able to tell you .. if a claim has been submitted.. if a claim has been rejected.. and what date/time and possibly the initials of the Pharmacist on the submitted/rejected claim.

Note the name of the representative of  your insurance company and date/time which you spoke..

I all likelihood, the Pharmacist in denying the filling of your prescription .. has violated the Pharmacy’s contract with your insurance company and lying to a pt.. may be considered “unprofessional conduct” by the Board of Pharmacy.. if a complaint is filed. As well as potential ADA civil rights/discrimination violations.

18 Responses

  1. Are controlled drugs really being rationed? I offered to leave scripts at pharmacy to be filled when shipment came in Friday and they said that they may not get what is ordered or someone else might come in.

    • I hear that the wholesalers are implementing some arbitrary rationing on pharmacies.. so .. if you can get a letter from your Pharmacist that you are not getting your meds because of wholesaler rationing.. My understanding is rationing is happening on a monthly basis.. so it may be more problematic at the end of the calendar month..then the wholesaler is the genesis of your discrimination and the wholesaler is also licensed by the BOP.. and IMO.. would be subject to a ADA complaint.

  2. Cvs in Smyrna Tennessee will not let me pick up my 30 day klonopin until the 30 th day. For 3 years I got a 90 day supply. Understand that this is 30 days per state prescription but did not see anything about 29 day pick up. Would have saved a 10 mile trip. Same place refused pain medication after surgery although I was going to run out late Saturday night. Had to wait until they opened Sunday.

  3. Someone correct me if I misunderstand…but if the pharmacy only accepts CASH on a CII or any other singled out medication and insurance on the rest and then jacks up the price on that ONE item and they ALL do it in one town or area…doesn’t that fall under price collusion, price gouging or something more serious regs???? Has anyone had any success yet filing complaints with their State AG, State Insurance commssioner, Insurance company, CMS/Medicare Fraud unit??? Anyone else on your list Steve??? I’m kinda relating it to the news of increased compliants in IN where I live when our gasoline prices seem to outpace the rest of the country and they report complaints of price gouging are up at our state AGs office. “Sqeaky wheel gets the oil” DEA had their hands tied in Oregon back in Feb by a district court regarding what and how they obtain records.

    • I can’t really prove this…I have heard it from multiple people. And the pharmacy where my fiancé goes to says they don’t carry 30 mg oxycodones any more, when in fact they do and only sell it to cash paying customers. The customers getting them are not going to risk losing their ‘dealer’ by telling anyone. Also if I start filing complaints, the pharmacy will drop my fiancé as a patient and he won’t have ANY meds at all. So what should I do?? !!!!!

  4. This has happened many times to my fiancé. I spent hours in the pharmacy talking to the insurance company on the phone while they are telling me it should go through, and the pharmacy, Ben, has spinal cord and nerve damage from 2 spinal fusions since 2001. He went to The same Walgreens until 2011 when they simply said ” we don’t carry that any more”. We found another pharmacy after a full week of driving to pharmacy to pharmacy to pharmacy. He was mostly told either “we don’t have that” or “I don’t feel comfortable filling that”. So he found a pharmacy that was great for about 2 years and they lost their distributor. So we did the “pharmacy crawl” again for about another week and found the one he goes to now. The first thing the pharmacist/ owner did was to cut the amount of Bens meds in half. NOT the Dr.!!!! This is medicine Ben has taken for over TEN years and he needs this to keep him from wanting to die. The pharmacist said if he didn’t like it he could go somewhere else. He knows how hard it was to find a pharmacy to fill his prescriptions. But here is why. On Christmas Eve AND New Year’s Eve he was told his Medicare part D was denying filling his regular script. I called them and they said there is no problem and they should go through just fine. I know that now that the DEA is limiting the amount each pharmacy gets, they are holding what they have for CASH paying customers that they can charge whatever they like for them. Well, WHO can afford 1500.00$ a month for their prescriptions???? A disabled man on Social Security that pays 900$? OR drug dealers? The pharmacy wants to make their money and they don’t care about my fiancé who was sick during Christmas this year. He says he is doing Ben a favor by filling anything for him, and he is suffering so much from only getting half his normal amount. But he is lucky to be getting any at all. I call pharmacies all the time trying to find a decent one that he can count on but NONE are taking new patients with insurance. CASH ONLY so the drug dealers gets theirs and the legit patients just suffer. Stupid DEA. Now look at your mess!!!!!

  5. So if the If the insurance company let’s it go through, it is good to go? My pharmacy will not release my oxycodone. The script states the 27th and it’s now the 29th. What can I do?

    • Most insurance companies will pay for a Rx when 75%-85% of the previous Rx should be taken.. Because so many RPH are fearful of the DEA’s intervention in the practice of medicine and pharmacy.. some pharmacies have settled down on “refills no sooner than two days early” Realistically, you should be able to have your controls filled every 4 weeks…. presuming that your Rxs for 30 days. IMO.. if you are at/past the 30 days since last fill.. and have a new Rx or authorized refills.. and you are being denied your medication…you are experiencing denial of service and if being thrown into withdrawal.. PT ABUSE. suggest you read the following including links within the post http://www.pharmaciststeve.com/?p=5246 & http://www.pharmaciststeve.com/?p=6021

    • Get the store manager to go with you as the pharmacist explains why you can’t have it. Maybe there’s a valid reason.

  6. Word PharmSteve!!!
    This is extremely HELPFUL!!!

    As always thank u for taking your own previous time on this Earth to help us who have been forgotten and abused. I can’t say it enough… Thank u!!!’

    • @Candice.. I must be irritating a lot of Pharmacist’s nerves.. particularly those that are opiophobic and hiding behind their “professional discretion” to justify their actions.. I am getting a lot of very negative emails.. but they apparently mistake me for someone who cares about their opiophobic beliefs and can be “converted” to share their beliefs.. IMO.. “the worm” is in the process of “turning”..

      • You’ve hit the nail on the head. I am a practicing pharmacist and I just don’t lie to patients. If you can’t fill it for a reason you support, like Walgreens policy, then say we need 2 days to fill these per policy. Don’t like that you have no percocet. If you don’t support Walgreens policy, and are embarrassed by it, then fill the prescription. Don’t make up new lies to protect Walgreens. If you have a real reason not to fill, tell the patient what’s going on.

  7. WhAt You Didn’t Clarify Is That DEA LAWS SUPERSEDE any Insurance ContRact. And Refills Allowed By
    Insurance May NoT Be By DEA LAWS..Soo BeforeYou TalkLearnAllTheRules

    • Why don’t you read what I write/say

      when the pt knows that they are within their prescribed dosing.

      Telling a pt that their insurance denied their refills when the pt last had a fill date 29-30 days..and their Rx is a 30 days supply… that the pt has to wait a couple of more days to be filled.. In most places in the civilized world … IS A LIE !

  8. I know my husbands insurance will fill controls 5 days prior to last fill. but the pharmacies around my town are all in the cohoots not to fill within 2 days of recent fill. I’ve already done this in the past. I’ve told the pharmacy this, they know I’m an RPh and I was told this was store policy, but they couldn’t show me the book…proprietary reasons

  9. What a great suggestion. I have been lied to so many times by ones who haven’t even looked at computer. But there is also the old I don’t have it and go elsewhere story too lol. Actually would think pharmacies would want the business.

    • If a C-II drug is involved.. Fed/State laws mandates that the Pharmacy maintain a perpetual inventory on each drug.. Filing a complaint of being lied to “I don’t have any in stock” .. it would take MINUTES for an investigator to determine how many – if any – quantity was on hand on a particular day and how many Rxs had been filled before or after you were told “no inventory” and likewise.. would be able to review invoices or DEA 222 Forms to determine when and how much of a particular drug was purchased. Other controlled drugs they would have to go thru daily Rxs filled and invoices to get some idea if there was inventory on hand.. that is why it is important for you to notate time.. all prescriptions filled have a time/date stamp on them. Rxs filled for the same drugs minutes-hours after one was turned down and no stocking orders had been received.. would be pretty conclusive about a pt being lied to..

  10. Thank you for all the information you bring us!!!!

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