Perscriptions and insurance. Pharmacy problem...

[lsyorke]

Ask a pharmaceutical salers rep. It is not unethical. It IS a loophole that is left there for a reason, and that reason is for a physician to use his/her descretion as to what is best for the pt.
It takes the red tape out of the pt. doctor relationship.
It IS NOT unethical, it is a way for pt's to overcome an insurance companies rule that was put in place not looking out for the pt.

So a doctor ordering a dose that is 3 times the "recommended dose" to cheat the insurance company is ETHICAL?? And what "red tape" is caused by a doctor prescribing a drug properly?

 

[CathrynRose]

So a doctor ordering a dose that is 3 times the "recommended dose" to cheat the insurance company is ETHICAL?? And what "red tape" is caused by a doctor prescribing a drug properly?

It's not 3 times beyond the dose - it's the 'normal' dose - yet she doesnt need it as often as perhaps it is written.

It's the same as an inhaler RX. It says 2 puffs, 3 times a day - but any asthmatic wouldnt be using it that much.

 

[crashbb]

Ask a pharmaceutical salers rep. It is not unethical. It IS a loophole that is left there for a reason, and that reason is for a physician to use his/her descretion as to what is best for the pt.

Sorry, I'm not understanding? What is the "loophole' that is left there for a physician to use his/her discretion? The range of doses? That's there because different people due to different body size/severity/tolerance etc. have different needs - not as a loophole for you to get out of paying the correct number of co-pays. Or is there another loophole to which you are referring?

Just because there is a loophole that can be exploited, doesn't make it ethical to do so.

 

[edwardsfire]

It's not 3 times beyond the dose - it's the 'normal' dose - yet she doesnt need it as often as perhaps it is written.

It's the same as an inhaler RX. It says 2 puffs, 3 times a day - but any asthmatic wouldnt be using it that much.

Thank you,
the dose written is for the legal maximum dose, although most dont need that.
Thus, one can "stretch" their prescription. It is perfectly leagal and done quite regularly to help pt's get more out of their co pays.
Look at it this way,
Insurance company WILL pay for 2 pills per day.
You only need to take one. and you DO take one.
But your script says take 2, that way your 20.00 co pay lasts 2 months instead of one. Saving you 20.00
simple,legal and common sense.

 

[lindalinda]

Thank you,
the dose written is for the legal maximum dose, although most dont need that.
Thus, one can "stretch" their prescription. It is perfectly leagal and done quite regularly to help pt's get more out of their co pays.

It's unethical at best. And I certainly don't believe it's done "quite regularly". And depending on the prescription type, it wouldn't even work in many instances. Co-pays vary according to drug type. Third tier prescriptions are priced per pill, and copays increase with amount. I have had Drs change some brand name prescriptions from 2 smaller pills to one larger dose in order to lower the cost. Of course, most insurance companies have plans for 90 day prescriptions anyway at a reduced cost.

legal, not leagal.

 

[rascalmom]

And what happens when the patient becomes ill or hospitalized and someone else is dosing their medicine?

I take a heart medication daily. It is also to be taken when I have a PSVT episode. I CAN pass out when this happens. If someone else were to need assist me, they should know what the real dosage actually intended by the doctor was?

My daughter takes an allergy/asthma medication - she is tiny & I am sure the legal dose is greater than is what is prescribed for her. But what if she got mixed up on which meds had "extras" and over-medicated herself?

This doesn't sound smart - ethically or medically.

You may find doctors doing this, but it sure sounds like insurance fraud to me....not to mention a putting a patient at risk for incorrect dosage. I don't think any doctor who does this is very smart - they are leaving themselves open for a malpractice suit.

There are medicines that are dosed "as needed" for the condition, but that is different than intentionally overprescribing for a patient's condition or need.

Insurance companies are a for-profit enterprise and most doctors work under some type of contractual agreement with them as providers - this would not be looked on kindly by the insurance company, I assure you.

And people wander why costs keep going up!

 

[edwardsfire]

It's unethical at best. And I certainly don't believe it's done "quite regularly". And depending on the prescription type, it wouldn't even work in many instances. Co-pays vary according to drug type. Third tier prescriptions are priced per pill, and copays increase with amount. I have had Drs change some brand name prescriptions from 2 smaller pills to one larger dose in order to lower the cost. Of course, most insurance companies have plans for 90 day prescriptions anyway at a reduced cost.

legal, not leagal.

thats fresh pointing out a spelling error. I did spell it correctly in my last line.
sorry for the missstake.
In anycase, It is done regularly and it aint no secret.
Of course another way to save money is for your Doc. to give you HUGE amounts of samples, im talking lots of them.

 

[edwardsfire]

And what happens when the patient becomes ill or hospitalized and someone else is dosing their medicine?

I take a heart medication daily. It is also to be taken when I have a PSVT episode. I CAN pass out when this happens. If someone else were to need assist me, they should know what the real dosage actually intended by the doctor was?

My daughter takes an allergy/asthma medication - she is tiny & I am sure the legal dose is greater than is what is prescribed for her. But what if she got mixed up on which meds had "extras" and over-medicated herself?

This doesn't sound smart - ethically or medically.

You may find doctors doing this, but it sure sounds like insurance fraud to me....not to mention a putting a patient at risk for incorrect dosage. I don't think any doctor who does this is very smart - they are leaving themselves open for a malpractice suit.

There are medicines that are dosed "as needed" for the condition, but that is different than intentionally overprescribing for a patient's condition or need.

Insurance companies are a for-profit enterprise and most doctors work under some type of contractual agreement with them as providers - this would not be looked on kindly by the insurance company, I assure you.

And people wander why costs keep going up!

If i responded to your paradoxical supra ventricular tachycardia, i can assure i would know EXACTLY what you need, without even knowing what your script says.
And to your comments, if you dare, ask your physician as per my comments..he will agree with me, it is a normal way to save people money.
but look, do what you want to.
Free Country. I just choose to save some of my cash.

 

[Abbie]

You keep saying it's done regularly but I don't agree. I've worked in a doctor's office for a very long time and I've never heard of any practice doing what you're saying is common. It's simply bad practice. All the doctors and nurse practitioners I know are very careful not to do anything that would jeopardize their licenses and if they are dispensing more medication than is needed and just hoping the patient will remember to take the correct dose, then they are putting their practice at risk.

Many doctors will work to help find a solution to keep costs down, including writing a prescription for a 10mg. dose and having you take 1/2 a pill (if it can be split) to stretch out your supply (assuming you're on 5mg a day). But the directions would clearly state "take 1/2 pill" so there is no confusion.

And in most offices, samples are meant to be given as samples, not to supply someone with months and months worth of a medicine just so they don't have to pay for it.

 

[edwardsfire]

You keep saying it's done regularly but I don't agree. I've worked in a doctor's office for a very long time and I've never heard of any practice doing what you're saying is common. It's simply bad practice. All the doctors and nurse practitioners I know are very careful not to do anything that would jeopardize their licenses and if they are dispensing more medication than is needed and just hoping the patient will remember to take the correct dose, then they are putting their practice at risk.

Many doctors will work to help find a solution to keep costs down, including writing a prescription for a 10mg. dose and having you take 1/2 a pill (if it can be split) to stretch out your supply (assuming you're on 5mg a day). But the directions would clearly state "take 1/2 pill" so there is no confusion.

And in most offices, samples are meant to be given as samples, not to supply someone with months and months worth of a medicine just so they don't have to pay for it.

Ok, one more time...
1. It IS legal.
2. It IS done regularly, Just because you dont know or maybe didnt ASK.
3. It IS safe. The maximum dose written is just that, a safe dose. See post 22
4. And yes, samples are samples, but even my wife (who has a different doc.)
gets samples out the wazoo.
I have had about 5 months of nexium before given to me.
It was a pain opening all the 5 pill containers and putting them in 1 nice big one, but it was worth it, cause its free.

 

[merryweather20]

Ok, one more time...
1. It IS legal.
2. It IS done regularly, Just because you dont know or maybe didnt ASK.
3. It IS safe. The maximum dose written is just that, a safe dose. See post 22
4. And yes, samples are samples, but even my wife (who has a different doc.)
gets samples out the wazoo.
I have had about 5 months of nexium before given to me.
It was a pain opening all the 5 pill containers and putting them in 1 nice big one, but it was worth it, cause its free.

Feel free to call your insurance company and ask. I already know what their answer is (and so do the other posters).

 

[edwardsfire]

Feel free to call your insurance company and ask. I already know what their answer is (and so do the other posters).

You think they dont know it is done?
It all part of the price of doing business.
Just like any other business, its all factored in.
the word i think of when thinking of the folks opposed or lacking knowledge of just how this is done....NAIVE

 

[Abbie]

Ok, one more time...
1. It IS legal.
2. It IS done regularly, Just because you dont know or maybe didnt ASK.
3. It IS safe. The maximum dose written is just that, a safe dose. See post 22
4. And yes, samples are samples, but even my wife (who has a different doc.)
gets samples out the wazoo.
I have had about 5 months of nexium before given to me.
It was a pain opening all the 5 pill containers and putting them in 1 nice big one, but it was worth it, cause its free.

1. I already acknowledged long ago it was probably legal. I still maintain it is NOT good medicine.
2. I have a lot of contact with many dr. offices and again, I don't know of ANY that do what you're saying. How many doctors have you had that do this?
3. It may be a safe dose written but it is NOT safe to have the bottle directions be different than what you (generic you) are supposed to be taking. I am thinking particularly of elderly patients who confuse easily, forget what the doctor verbally said, but read the bottle and take what's written on there. Regardless of saving money, that is a lawsuit just waiting to happen.

 

[edwardsfire]

1. I already acknowledged long ago it was probably legal. I still maintain it is NOT good medicine.
2. I have a lot of contact with many dr. offices and again, I don't know of ANY that do what you're saying. How many doctors have you had that do this?
3. It may be a safe dose written but it is NOT safe to have the bottle directions be different than what you (generic you) are supposed to be taking. I am thinking particularly of elderly patients who confuse easily, forget what the doctor verbally said, but read the bottle and take what's written on there. Regardless of saving money, that is a lawsuit just waiting to happen.

HUH?
im talking about a pt. asking their doc to do this, why would it be dangerous?
YOU WILL know what to take because YOU ask. If it is confusing, dont do it.
Now, tomorrow, ill be transfering all my rx's to another pharmacy to get the gift cards, then back to my old one a few months later....life is simple.
but how can one be confused if they are the ones doing it.
Even if you DID take the written dose, it will be harmless. why? cause its the maximum dose for YOU. It wont matter other than peeing money down the toilet.
The RX has the maximum dose on it. No worries, If you are doing this, you DONT need the max dose. It wont hurt you though if you took it.

 

[rascalmom]

If i responded to your paradoxical supra ventricular tachycardia, i can assure i would know EXACTLY what you need, without even knowParoxysmal supraventricular tachycardia ing what your script says.
And to your comments, if you dare, ask your physician as per my comments..he will agree with me, it is a normal way to save people money.
but look, do what you want to.
Free Country. I just choose to save some of my cash.

When I have a paroxysmal supraventricular tachycardia episode, I would NOT want to rely on my memory, or that of my family member who may be helping me get the meds to decode the prescribed dose back to the intended dose.

For any medical professional to allude or recommend this is irresponsible. How many financially strapped or older people would be enticed into using this technique to save money, but due to age, memory loss, or the stress of illness later have confusion over the correct dosage?

I have a very elderly grandfather. He doesn't see well and sometimes get confused. He is also quite miserly. If he heard this suggestion, you could be darn sure he would be asking his doctor about this at his next appointment. He would not, however, be able to keep it clear on how much to take of what & when. It has to be clearly labeled! But he would certainly ask if he got wind of it.

This only works if you have a fixed or tiered copay anyway. Many drug co-pays are based on a percentage of the cost of the prescription, so no money would be saved.

I am flabbergasted that anyone would suggest this and I would run fast from any doctor who condoned it. The prescription should agree with what is in the patient's chart. If samples are distributed, that should be noted in the chart.

I know dh would never prescribe this way - ever. He is a dentist, so he rarely prescribes anything but pain medications and antibiotics, but still.....never, never, never. It is not worth risking the patient or the practitioner's license.

 

[Tinkerbelle'sMOM]

That is so not good medicine...as an RN, and an advanced practice nurse, I can tell you that is very frowned upon, and in 22 years where I have been, I can honestly say I have never seen this in practice where I work. Sure, it is the max dose for that med, but when you hit max doses you can have certain side effects, and not all max doses are safe. If something were to happen to you, you have to go to the hospital and are unable to respond to them, they pull your record and get that prescription info. Gee, he is taking X amount of this drug, these are the adverse side effects, he has this one...and therefore they can be thrown down the wrong pathway as to what is wrong with you thinking that the meds could have caused it, not something else.

Also, if the doc is writing one dose in your chart and it doesn't match up with what he prescribes, he could eventually get in trouble, but that is his problem, not yours.

 

[chloelovesdisney]

When I have a paroxysmal supraventricular tachycardia episode, I would NOT want to rely on my memory, or that of my family member who may be helping me get the meds to decode the prescribed dose back to the intended dose.

For any medical professional to allude or recommend this is irresponsible. How many financially strapped or older people would be enticed into using this technique to save money, but due to age, memory loss, or the stress of illness later have confusion over the correct dosage?

I have a very elderly grandfather. He doesn't see well and sometimes get confused. He is also quite miserly. If he heard this suggestion, you could be darn sure he would be asking his doctor about this at his next appointment. He would not, however, be able to keep it clear on how much to take of what & when. It has to be clearly labeled! But he would certainly ask if he got wind of it.

This only works if you have a fixed or tiered copay anyway. Many drug co-pays are based on a percentage of the cost of the prescription, so no money would be saved.

I am flabbergasted that anyone would suggest this and I would run fast from any doctor who condoned it. The prescription should agree with what is in the patient's chart. If samples are distributed, that should be noted in the chart.

I know dh would never prescribe this way - ever. He is a dentist, so he rarely prescribes anything but pain medications and antibiotics, but still.....never, never, never. It is not worth risking the patient or the practitioner's license.

ITA! It is very irresponsible and dangerous for doctors to purposely write prescriptions with the incorrect dosing directions. Taking the wrong dose of medication can be very dangerous even if it is a dose within the normal limits. It's still not normal for you.

 

[bumbershoot]

Long story
DH went to get DS perscription at pharmacy...I will not give name but it is not RITE to do this to people. I thought they were there to AIDE people . Perscription is supposed to be for 2 tablets once a day. They gave us 30? That is enough for 15 days. I call to make sure DR didnt write it wrong. I am told that my son's insurance will not cover the whole perscription. Ummm it did last month. I am told it changed in 2009. Ok so whom do I call, Dr. or insurance She tells me insurance. I ask which one denied it. She says there is only one Medicaid. I say no, there are 2 Blue Choice and Medicaid. I am told again no, only one. I tell her I was there last month and we had a problem...blah blah..I had to pay because other med was not covered. I ended up paying $35 just the copay. She says she has nothing. I ask her to check my DH account to see his number. Yup its there but nothing under DS. Ok can I please talk to pharamcist. He gets on the phone...blah blah...no number listed. Are you crazy we have been getting perscriptions for years and years. He asks again for DS info and then looks again. Oh there it is he tells me. Um no that is DH's soc security number. I have a card in my hand with DS name and number and it has a 2004 date. I tell him the number and he changes it in the computer. Then he tells me I never gave them the new one. I again say they billed DS perscription to it in Nov/Dec. He has no idea how that happened. I am done. I just say ok and hang up. I then call another branch of the RIGHT pharmacy hoping they can AIDE me. The man there looks up DS account and says the new number is listed with todays date. That they did have a different number but he cant access it because once a new number is in the system it wipes out the old but there is a key saying new number or changed number. I ask if someones account has been being billed for my sons persciptions. He does not see how that could happen.He then goes on to say BC has never been billed for perscriptions!!! There is only a record of one perscription being billed to BC They have all been billed to Medicaid. This is not right I say and he says, yup it is not right at all. I ask if this is something I can get in trouble for. He says that probably since it is on the reciepts and since I never corrected it It could be fraud. Well, I have to admit I never look at them. I dont pay a copay so I dont read them. Now what??? Do I call Medicaid and tell them? Do I just wait for next time and check and then go down if its wrong? Do I call BC?? Anyone????

Call the insurance company(ies?). Get the info from them. Obviously this pharmacy has some awful record-keeping practices.

Start looking at the EOBs when they come in, and keep them in a file folder with your prescription receipts. See if they add up.

And always check the label right then and there. Hubby and son went to the Target pharmacy with MIL to help her get her drugs for an upcoming colonoscopy (MIL is Korean and is losing her English skills as time since her husband died goes on, and "medical English" has never been understood by her). It was supposed to be TWO pills of some sort, along with other stuff. They waited well over an hour, even though the doctor's office called it in an hour BEFORE they went there. When they finally were called, they checked the bottle and they had given her 30 or 60 pills. Actually I think they only caught it when they wanted to bill MIL over 100 bucks.

So they had to send it back, the Target pharmacists couldn't just dump the extra into something and give her the bottle with 2 pills from the first bottle, and be done with it...no, they had to wait another half hour for them to reinvent the wheel, er, re-do, from scratch, the whole prescription (wow it's easy for the fingers to type er instead of re!), and she only had to pay a few bucks.

Check right then and there from now on.



Also, why didn't they tell you right then that the insurance company would't pay all of it? All the prescriptions we've dealt with recently have the financial stuff done *right then and there*. And MIL is on medicare, not the least red-tape-y sort of place there is, but they know right at the register what is her portion and what is her supplemental and what is out of pocket.


Definitely time to find a new pharmacy, while getting everything worked out with the old one. Also find out why on earth your son's insurance was changed without you knowing! You're going to have a long day of calling the insurance company tomorrow...I wish you luck!

 

[npmommie]

Thank you,
the dose written is for the legal maximum dose, although most dont need that.
Thus, one can "stretch" their prescription. It is perfectly leagal and done quite regularly to help pt's get more out of their co pays.
Look at it this way,
Insurance company WILL pay for 2 pills per day.
You only need to take one. and you DO take one.
But your script says take 2, that way your 20.00 co pay lasts 2 months instead of one. Saving you 20.00
simple,legal and common sense.

That is so not good medicine...as an RN, and an advanced practice nurse, I can tell you that is very frowned upon, and in 22 years where I have been, I can honestly say I have never seen this in practice where I work. Sure, it is the max dose for that med, but when you hit max doses you can have certain side effects, and not all max doses are safe. If something were to happen to you, you have to go to the hospital and are unable to respond to them, they pull your record and get that prescription info. Gee, he is taking X amount of this drug, these are the adverse side effects, he has this one...and therefore they can be thrown down the wrong pathway as to what is wrong with you thinking that the meds could have caused it, not something else.

Also, if the doc is writing one dose in your chart and it doesn't match up with what he prescribes, he could eventually get in trouble, but that is his problem, not yours.

It may be legal but it is unethical at best. For one thing like Tinkerbelles mom said.......the chart will say one dose and the script another. This could come back to bite the doc in the butt.
I have never in all my years of practice seen this occur , I don't believe at all that it is common practice.

One of my very good friends is a physician, i am going to ask her if she has ever heard of this practice. I suspect I already know the answer.

 

[CPT Tripss]

You think they dont know it is done?
It all part of the price of doing business.
Just like any other business, its all factored in.
the word i think of when thinking of the folks opposed or lacking knowledge of just how this is done....NAIVE

Yeap . . . just rationalize this "I'll look out for me and damn the consequenses to anyone else" behavior away.