I received a phone call from a independent Pharmacist …
The following story was relayed ….This RPH had a pt patronize the store for some 4-5 yrs.. in fact this particular pt was almost like a family member.
This particular pt started needing dialysis .. and was referred to a national company call DiVita www.davita.com
for dialysis… because of Medicare bundled reimbursement for dialysis pts.. they are to provide the drugs used directly with/during dialysis.
Some where along the line.. DiVita asked the pt if he/she wanted DiVita to provide all his/her medication via mail order.. the pt declined..
At one point.. the RPH tried to fill one of the pt normal HTN medications… and got a rejections.. it would seem that DiVita had filled/refilled this medication when the pt had used 60 days of a 90 days supply.. which the pt had refused delivery and returned to sender.
Long story … short… there is a four-way phone call between RPH, insurance representative, pt and DiVita representative… the DiVita rep asked the pt .. why he/she did not want to stay with them.. claimed they could not find the refused Rx.. pt repeatedly stated that he/she did not want to use mail order and wanted to use his/her local pharmacy.
Supposedly, the DiVita rep claimed that the pt had signed a form requesting that DiVita fill all the pt’s meds… but declined/refused to provide a copy of such.
All told 30 + minutes on the phone.. the wait between first DiVita rep and second rep.. was so long.. the pt hung up.. but the second DiVita rep insisted on talking to the pt about his/her request to not use mail order.. even though the insurance company rep was on the phone .. heard the pt say that he/she was not interested in using DiVita for his/her normal meds.
Are we talking about denying a pt’s freedom of choice under Medicare here ?
According to this RPH.. CMS was contacted that they were not going to get involved.. it was a insurance company issue.. Doesn’t the insurance company’s contract with CMS require them to protect the pt’s freedom of choice ?
Is this just another situation.. of the bureaucrats having rules/laws.. that they have no interest enforcing… I guess that they are just too busy writing new rules and regulations… to enforce the ones on the book..
Filed under: General Problems
Speaking of mail order I had an interesting situation. Recently OptumRX stopped our contract with them at the pharmacy I work at. One of our patients is a OptumRx customer. Her daughter deals with her medications and called me to transfer her meds to the mail order facility so they can bill the insurance. I informed her of the normal way things go. The new pharmacy calles the one that has the prescription. She told me the mail order facility told her I would have to call them to give it to them. I was shocked but curious, so I called. When I finally got a pharmacist I asked. Yes she was told correctly, if I was to transfer the rx to the mail order I had to call, it was their policy. This may seem like a small thing but it demonstrates the arrogance they have when dealing with “real world” pharmacy. I left an email asking if that was really the policy. I await their response, not holding my breath though.
So anyone could call of this mail order firm and give them a “copy”. I guess they don’t care if it is a valid pharmacy,pt, or doctor.. It is all about filling them…and getting the volume ?
Just reverse this scenario and let it be a pharmacy not complying with CMS regulations and then see what happens. Justice….where is the justice in this country? Looks like it is on the side of the ‘money’. Yes, justice is blind to everything but the money. The little guy does not stand a chance.