Rumor on the street 08/08/2014

rumoronstreet

 

 

 

 

 

 

Got this phone call today… apparently this long time chronic pain pt had been having some problem with a particular pharmacy.. all of a sudden the RPH wanted to interfere with the pt’s therapy.. demanding that the pt’s prescriber reduce or eliminate some of the pt’s medications. Apparently, threatening the prescriber of turning the prescriber over to the DEA concerning the therapy that the  prescriber was writing for. Wanted the prescriber and the pt to “develop a plan of treatment ” for the pt’s multiple chronic conditions.

The pt tried to comply, but was not happy that with the RPH’s interference with the therapy… so the pt filed a complaint with the pt’s insurance company… This patient has a Medicare Advantage plan with the largest insurance company that has the endorsement of the largest National Senior Citizen Association.

Apparently this RPH was not too happy.. because this pt’s insurance company has opened an investigation with the pharmacy that the complaint was filed on and the RPH refused to fill this pt’s prescriptions…

The pt took the Rxs to some of the chains and they were happy to fill the non -controls the pt had …but.. none would fill the controls.. one RPH told the pt that the company would not allow them to order C-II’s..

This pt called the insurance company that requested that they find a pharmacy within their advertised 64 K pharmacy network that could fill the Rxs. They claimed that they could not find ONE PHARMACY in their network in the sizable geographic area the pt lived in that would fill this particular pt’s controlled meds ?

The representative first suggestion was that the pt go to a local emergency room.. to get them to give the pt a RX for enough to allow their mail order firm to fill the Rxs – TWO WEEKS… Did I mention the pt was out of meds, it is a FRIDAY and the prescriber is out of the office.  We all know how willing ER’s are to give pts a couple weeks of C-II’s

The pt ended up over nighting the Rxs to the insurance company’s mail order firm .. who is suppose to over night the Rxs back to the pt… who is believes that the pt will get the meds post haste ..or even if the mail order firm will fill them at all ?

I get the impression from this pt that there is going to be a lot of complaint forms that are going to be filled out…  I suspect that there is going to be more to this story..

6 Responses

  1. WOW! It looks like the insurance company’s formulary and contracts are now optional.Sounds like a good trade off for increasing premiums no?

    in Kanas now, a pharmacist can even change a pt Rx WITHOUT consulting the prescribing doctor. Personally I know I’d feel safer with my pharmacist having final say in treating my rare autoimmune disease (that most DOCTORS are totally oblivious to).
    http://cjonline.com/news/2014-07-07/pharmacists-say-collaboration-bill-will-improve-care

    Its good to know that state legislatures are always looking out for the patient’s best interests as they are experts on just about everything…………..

    From the above link:

    In a state that is increasingly short of physicians, especially in rural areas, Burger said it is time for pharmacists, the “most underused resource in the health care community,” to fill the void where they can.

    “We’re the most available health care worker out there,” Burger said. “There’s one on almost every street corner. So, pharmacists need to be more involved in patient care.”

    Question: Pharmacists are flexing some serious muscles recently. Are they really that afraid of being replaced by vending machines?

  2. As usual, the story Steve presents has some holes in it. Its hard to imagine that an independent pharmacist would drop the hammer on a long term paitent for no good reason. I’d like to know what triggered this reaction from the pharmacist. It would be a safe bet that there is a good reason for it.
    As far as poor service from chain drug stores, that just has to be expected. But when a patient gets turned away by every pharmacy he visits maybe it says something about the patient and not about the pharmacies.

  3. I haven’t worked retail pharmacy in almost 2 years. What has caused this to happen now??? I’m confused. I never, ever had a problem getting CIIs for patients who were regular, local patients at my pharmacy. Why is this happening?

  4. Such a shame. How can a professional act in a manner that puts the patient in jeopardy. Shameful. Praying he loses his heartless licence for discrimination. Makes me ashamed to live in the same world.

  5. This guy is one of many including myself I raised holy hell and got absolutly nowhere……

    per steve: can you elaborate on “holy hell “?

  6. I hope this patient takes it ALL the WAY! It’s about time that somebody gets down and dirty with these pharmacies, insurance companies and sometimes the doctors too. The violations that have occurred with this case are huge. It’s complete BS that any Rph would try to position themselves as the doctor . They don’t know how to treat diseases. WTH?? I hope this goes FULL VIRAL and this patient will have plenty of support behind them because far too many patients are living this hell these days.

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