Tuesday, August 16, 2011

Ugh !!! Those lines ...

Working the Pharmacy Department, I realize just how many people look over a few simple steps in their Health Care Management System.   Things we all too often just don't think about.

For example: Jobs ~ When relocating to another city or state, we tend to "dot" the i and "cross" the t when it comes to job hunting or transferring from the company in one state to the same company in another.  You are prepared, know exactly what you are doing, working, and who is your first point of contact before your first scheduled day.  With Schools ~  We read and take into consideration the feedback of those who might have left good or bad comments.  We visit the school and the area in which it sits.  Check out the classes available, the activities offered to our children, and even investigate to see if there are any criminal backgrounds on the teachers.  We look into the local hospital, the Physicians offices, Malls and Grocery stores. 

No stone is left unturned,  right?  You have pretty much covered all the basics and have done the proper homework.   The move goes off without a hitch.  Everything is in your new location.  You are all settled.   Perfect, couldn't have been better.  

Upon your first Dr visit, you are given a prescription.  He asks "would you like that called into the local pharmacy?"  in which you reply "Sure, is it pretty close?" 

This is more common than not.  Every day people move to a new city and transfer to a new state.  Although all the home work is done, or so you thought, the pharmacy is always left out.  No one remembers to check with local pharmacy's.  Most people think there isn't a need to.  Your Dr has all your medical history, your insurance information, past and present medication, besides most people think that just because they use XYZ in their old town, that XYZ in the new town will have the same information.  

I mean, the pharmacy name is the same, so who would think otherwise?  Such a common mistake.

I would like to share a few tips ... so many people comment on how long it takes at XYZ to get a prescription filled.  The wait is always an hour or longer, the lines are so long.  Ugh !!  Besides,  who wants to leave the prescription and come back later?    I mean when you're not feeling well, you want to get home and climb in bed. 


Information is a big reason for the wait.  So many people feel that because the Physician Office called in your medication, that the insurance information and your personal information is given as well.  It does not work that way.  Sorry.  If your prescription is called into a pharmacy where you have never filled before, or it has been years that you've filled anything at said location... The Pharmacy will need all your current imformation.  

It is impossible to fill your medication and add you to the computer system as "Jane Doe 1"  or send a claim to Jane Doe 1's  insurance, when that pharmacy does not have any insurance information.  Even trying to call you to get the information is impossible, because the number the pharmacy has for you is 7 year old.  And is now disconnected.  To top it off, the pharmacy has left 2 or 3 messages with the physicians office to get your contact number, but they are out to lunch now for the next hour or so.   

You now show up at the pharmacy, expecting to pick up your medication.  

"I'm sorry, It looks like your prescription is not ready yet."  You are told  

With the look on your face alone, the cashier knows you are very upset.  You say  "I went to the Dr's hours ago.  Had lunch with my family, and you are telling me my medication is not ready!!  There is no reason my medication shouldn't be ready by now.  Just how much longer is this going to take?" 

Being on the front line is not an easy thing to do,  the cashier or customer service rep sees the customer, assists the customer, and is the unloading zone for an angry customer.  In order to move things right along in any pharmacy, here are a few pointers ...

First rule of thumb if you are new to the area, or are transferring from one pharmacy to another.. Make a point to stop by the pharmacy and give them your personal information.   While doing this, you can give them the phone number of the pharmacy you were using, and have any outstanding refills moved to your new pharmacy location.  Even if you do not need your medication refilled, it is best to have them transferred over to the new pharmacy.  Remember, the physicians office does not give the pharmacy your insurance information.  It is wisest to stop by the pharmacy drop off window and make sure they have all your information if you are new to that pharmacy location.

Second thing to remember... Any change in your personal information needs to be given to the pharmacy.  Why?  Because a prescription has to be filled the way the physician wrote it.  Example.. Pharmacy has you listed as Jane Doe, but you are now married and your last name changed.  9 times out of 10 the pharmacy computer system will see you as a new patient, and although the medication will be filled, it will not be applied to your insurance.  Therefore, you will be charged full price for the medication.  

 Third thing that is a must... When you get a new Rx insurance card in the mail; it is best to bring it to the pharmacy and have one of the techs at the drop off windows check to see if any of the insurance information has changed.  So many times, patients will get a new card, and not inform the pharmacy until new medication is filled and the cost of the medication is higher then the month before.  Almost every single time, a patient insurance claim is denied by the insurance company and the message given to the pharmacy is "Need new insurance information".  You may look at the card and not see a change in your ID number or Group number.. but the location where the claim is sent has changed.  It is those numbers that the pharmacy needs to update.

Keep in mind, it is your insurance company that decides what you, the patient, pays for the medication.  The prescription is entered into the computer system,  an insurance claim is sent right then {instantly uploaded to your insurance company}, a reply is sent back to the pharmacy as to whether the drug is covered, if the patient is covered, and what {if any} copay is the responsibility of the patient.  

Yes, maybe your medication was cheaper last month than this month and your insurance has not changed at all.  Many factors play a role in the reason why.  The cost of the medication may have gone up on the vendors end.  Your insurance company {at any time with no notice to you} might have dropped coverage for that medication, you might have not met your yearly deductible, or you might be in the donut  hole with your insurance company,  it could also be an outside vendor is supplying that medication due to a supply and demand problem.  Keep all of this in mind as you are picking up your medication. 

 The smartest thing to do, is know your insurance company.  What medications they will or will not cover. Ask for a list if they have one, keep it handy when you see your physician and make sure you get updated copies often.  The insurance can change their medication list at anytime without notification to you.   Also, do yourself a favor and go online; Google the maker of your higher priced medications.. see if there is a coupon you can print out to help you save money on that drug.  Check to see who is offering "Discount Drug Cards"  Google it, and see what you come across.  Some of those discount cards  offer up to 75% off your medication... and make sure to read the fine print.. those cards say "UP TO 75%" ; that could be .50 cents to bigger bucks.  While some of them in smaller print clearly state "Can not be used with ANY other discount offer"  alot of those cards will not work with your current insurance company because  you are already getting the medication at a "discount" when applied to your insurance.

Be informed.  Take an active role in YOUR Health Care.  The trip to your pharmacy should be an effortless stress free experience for both your pharmacy staff and yourself.

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