Perscriptions and insurance. Pharmacy problem...

[CathrynRose]

*Overwriting RX's*

This is really kind of silly. NO ONE here has had a prescription for anything, that they didnt take ALL the pills at ALL the pill bottle dose times? Ever been in an accident and had an RX for Vicodin - 2 pills / 3 times a day? You'd be a zombie... Same thing for a muscle relaxer if youve ever hurt your back. 3 times a day.

 

[daughtersrus]

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.

I can't believe that this is the least bit common. I have a DD that has a rare genetic disease. As a result, she is on two meds and NONE of her doctors have ever suggested that they write the script for more than she needs. I checked with some moms on another board that I'm on, and none of them have ever heard of this common practice.

I'd have to wonder what your doctor's Med/Mal insurance provider would think about him/her writing scripts for a larger dose than is required.

As for fraud, sure it is. The doctor is writing a script for a dose much higher than needed so that the insurance company will pay more and the patient less. I wouldn't be surprised if the insurance company caught it themselves since you are only getting a needed prescription every 3 months instead of every month. Why is insurance covering a medication that is available OTC?

As for samples, they are just that, samples. If the doctors chooses to give all of the samples to one patient, that is their choice.

 

[teacherforhi]

*Overwriting RX's*

This is really kind of silly. NO ONE here has had a prescription for anything, that they didnt take ALL the pills at ALL the pill bottle dose times? Ever been in an accident and had an RX for Vicodin - 2 pills / 3 times a day? You'd be a zombie... Same thing for a muscle relaxer if youve ever hurt your back. 3 times a day.

But those also say "as needed for pain". Those types of medications aren't meant to be taken on a regular dosing schedule. The label tells you the maximum you can take in a single day.

However, if you're taking a medication for an illness, heart problems, or the like, I fully expect that person to take it as directed on the label.

 

[edwardsfire]

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

One must always look out for number 1. Thats life.
But look, i know its done alot and if you dont wish to, than thats fine.
Do what ever you want. I will choose to do something that is:
1. Legal
2. Accepted (alot of Physicians do this) Regardless of what you think.
3. It saves me money.
But, free country. Do as you wish.
Peace
By the way, there is alot of meds insurance pays for that IS available OTC.

 

[daughtersrus]

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

You keep saying that it's not fraud but you're wrong. Why should I pay a higher premium because you won't pay your co-pay every month?

http://www.sbnonline.com/Local/Article/11046/81/104/Medical_fraud.aspx

...Insurance fraud, waste and abuse is estimated to take up at least 10 percent of total health care dollars spent with an estimated total of $260 billion annually by 2010, says Cissy Walker, director of audit services for AvMed Health Plans of Gainesville. “Health care fraud, waste and abuse is a menace to each person, their family and the future of health care,” says Walker. “It results in higher premiums or fewer benefits, higher co-payments and even higher taxes...

...Physicians are also not exempt from participating in fraud schemes, to include performing medically unnecessary procedures, accepting kickbacks or bribery, billing free services, duplicating billing, waiver co-payments or deductible, misrepresenting a claim, selling filled prescriptions on the black market, prescribing to self or family and over-prescribing to patients.

Here's another link for you.

http://www.wpsic.com/partd/2009_fraud.shtml

Some examples of Fraud and Abuse

Physicians/Prescribers

Over-prescribing drugs

The word that I think of is not naive but fraud when I think of what you are doing.

 

[barkley]

i have'nt had to deal with this for awhile (retired) but here is what i would suggest (from when i supervised a medicaid unit)-

first-take a deep breath, you have not committed fraud.

second-call your medicaid worker, ask them to look on their computer to see what your current and past history shows for how your ds is coded (should show what type of medicaid he's eligible to and what if any other insurance exists). if it shows what you know to be the case then it's an issue with the pharmacy's system. if it's not correct advise the worker and cover yourself by sending a letter (keep a copy) that confirms the conversation and what you had advised the worker.

third-if the medicaid system is incorrect and you want to continue to use that pharmacy AND/OR you feel you are owed money from the pharmacy because you overpaid your co-pays due to their error, see if you can get a screen print of what the medicaid worker's computer shows to take to the pharmacy to pursue it. if you're not going to use them/not owed a refund, call around to other local pharmacies and advise them you had an issue with another pharmacy so you want to know before you start using them if they will look you up on their link to the medicaid system to ensure their system is reading it correctly.


i know it's a pain, but often it's an issue with the individual pharmacy's software (if your medicaid is correctly coded by the state). there was one particular chain in california that was horrendously problematic when i administered the program and they KNEW their software was an issue but so long as they got paid by SOMEONE (did'nt care that they were disadvantaging either the customer or in the case of dual coverage the state) they did'nt care.

 

[daughtersrus]

One must always look out for number 1. Thats life.
But look, i know its done alot and if you dont wish to, than thats fine.
Do what ever you want. I will choose to do something that is:
1. Legal
2. Accepted (alot of Physicians do this) Regardless of what you think.
3. It saves me money.
But, free country. Do as you wish.
Peace
By the way, there is alot of meds insurance pays for that IS available OTC.

You may be looking out for yourself but that doesn't mean that it's legal.

Your doctor may do this, but it's doesn't mean that it's done a lot or that the doctor isn't risking their medical license so that you can save $20 a month.
Maybe your doctor would be interested in these links.

http://health.state.tn.us/Downloads/g6032094.pdf
Beckwin, Joseph, 14759: 9/27/01-License revoked by
the Alabama Board for unprofessional conduct, unsafe
practice, and inappropriate and/or over prescribing.
Default order-License revoked.

http://www.okmedicalboard.org/miscFunction.php?filename=20020301MD.htm&header=1

Two licenses were surrendered in lieu of prosecution, one for over prescribing and prescribing without need of CDS

 

[KAMLEM]

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.

Maybe you don't consider it unethical, but many others do. It's also INSURANCE FRAUD!

This is really kind of silly. NO ONE here has had a prescription for anything, that they didnt take ALL the pills at ALL the pill bottle dose times? Ever been in an accident and had an RX for Vicodin - 2 pills / 3 times a day? You'd be a zombie... Same thing for a muscle relaxer if youve ever hurt your back. 3 times a day.

This is a different situation. The doctor wrote the prescription not knowing how much you may actually need. In the other situation the doctor is writing the prescription KNOWING that the patient doesn't need it all.

 

[JustcallmeHappy]

Maybe you don't consider it unethical, but many others do. It's also INSURANCE FRAUD!

Totally agree!!!!

 

[LisaR]

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

Because the insurance company knows it is being done does not make it legal!

People do illegal drugs and rob banks. The police know these things happen. It doesn't make it right just because they know.

Sorry, but this is fraud. You are ripping off your insurance company with the help of your doctor.

And any doctor who would write a prescription for extra antibiotics in case your kids get sick again should be ashamed. Is it any wonder we are constantly hearing about the overuse of antibiotics?

 

[pweyl36]

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.

I work for a family practice dr and he never does this,also just to let you (op) that INS CO. do chart reviews each yr. and if they happen apond your chart then your dr will be in hot water.

 

[pweyl36]

And any doctor who would write a prescription for extra antibiotics in case your kids get sick again should be ashamed. Is it any wonder we are constantly hearing about the overuse of antibiotics?[/QUOTE]

I was thinking the same thing you dont always need anitbiotic when your sick. This is why mrsa is running rampant these days.

 

[wall*e2008]

OP I have no idea what to do. Good luck

One thing i do and my Physician is this:
He writes the prescription for as many "pills" as you can for the daily dose..
Then he tells me how many to actually take.
This way, my monthly prescription lasts up to 3 months.
I.e, i take Prilosec (1) time per day.
On my RX though it tell me to take 3 per day.
Therfor, i get a 90 day supply for the 20.00 copay.
It is done alot but you need to let your Doc. know.
Remember, take what the Doc. tells you to take, not whats on the bottle.
We do this for antibiotics for our kids also, that way you have a full round next time the kids get sick. But only pay 1 copay. Again, your doc. will know exactly what to do.

This is insurance fraud and you and your Dr. are involved. The Dr. could get in trouble if you took the Rx amount not what he told you.

On another thread you told us how you are not effected by the economy. Now we all know why.

 

[wall*e2008]

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.

I also have asthma. I do not use my rescue inhaler every day but the Rx is written for the maximum I am allowed to use it IF I need it.

That is not what our buddy Ed is doing.

 

[luvdzne]

I have all of our Drs write normal everyday used Rx out for 3 months supply at a time. My insurance actually gives me a discount this way. I take the Rx to CVS they fill it and I pay a for only 2 months supply and get the 3rd month supply for free. Saves me money this way. Maybe this is what edwardsfire is talking about?

I should add that the correct dosage is written on the bottle it's just 90 pills instead of 30 or 3 inhalers instead of 1.

 

[monkey68]

Is this legal? I thought that it was insurance fraud for a doctor to prescribe a medication or treatment that is not needed. Isn't that what the doctor is doing by prescribing a higher dose than what is needed so that the patient can have extras?

Don't know if it's legal, but it doesn't seem very safe, although it does happen quite often, but I would hope only if it was an established patient that the doctor knows quite well. But there could be all sorts of lawsuits waiting to happen, or insurance questions if they get audited. Can you imagine, if a patient is meant to be taking a drug every day, but the prescription only gets written every 3 months, and it's written for a one month supply, doesn't look so good for the doctor.

 

[npmommie]

*Overwriting RX's*

This is really kind of silly. NO ONE here has had a prescription for anything, that they didnt take ALL the pills at ALL the pill bottle dose times? Ever been in an accident and had an RX for Vicodin - 2 pills / 3 times a day? You'd be a zombie... Same thing for a muscle relaxer if youve ever hurt your back. 3 times a day.

a PRN med for pain is very different than what edwardsfire is talking about. a pain med can be taken a certain way, and no more. you don't have to take it at all, or take the max dose allowed.
edwardsfire is talking about an entirely different scenario

One must always look out for number 1. Thats life.
But look, i know its done alot and if you dont wish to, than thats fine.
Do what ever you want. I will choose to do something that is:
1. Legal
2. Accepted (alot of Physicians do this) Regardless of what you think.
3. It saves me money.
But, free country. Do as you wish.
Peace
By the way, there is alot of meds insurance pays for that IS available OTC.

It is not done a lot. In fact your MD may be the only one doing this. It is fraud and when they review his charts it will bite him in the behind.

I have all of our Drs write normal everyday used Rx out for 3 months supply at a time. My insurance actually gives me a discount this way. I take the Rx to CVS they fill it and I pay a for only 2 months supply and get the 3rd month supply for free. Saves me money this way. Maybe this is what edwardsfire is talking about?

I should add that the correct dosage is written on the bottle it's just 90 pills instead of 30 or 3 inhalers instead of 1.

I don't think that is what he is talking about. what you are doing is perfectly acceptable and fine.
edwardsfire is talking about knowingly having the doctor write the prescription for more than he needs so he can save money.

 

[edwardsfire]

a PRN med for pain is very different than what edwardsfire is talking about. a pain med can be taken a certain way, and no more. you don't have to take it at all, or take the max dose allowed.
edwardsfire is talking about an entirely different scenario

It is not done a lot. In fact your MD may be the only one doing this. It is fraud and when they review his charts it will bite him in the behind.



I don't think that is what he is talking about. what you are doing is perfectly acceptable and fine.
edwardsfire is talking about knowingly having the doctor write the prescription for more than he needs so he can save money.

How is it illegal? Actually, i know it isnt.
How will it "bite him?"
I take one one Generic prilosec per day.
The rx states "take two".
My doc knows im taking one.
This IS done alot.
I get two months for the price of one.
How can this not be understood?

And, one CAN and many DO take 40 mg's (2) prilosecs per day.
PPI's are harmless drugs.

 

[Nancy]

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

Answer is fraud. Had a little chat at work about this and made for some interesting conversations with the higher ups.

Maybe this is why the PBM's (pharmacy benefit managers like Medo etc) are getting a lot tougher with our members and how many pills they will allow.

People that abuse the system and think they are pulling a fast one and "not doing anything wrong" ruin for those that follow the rules and do things right.

I have all of our Drs write normal everyday used Rx out for 3 months supply at a time. My insurance actually gives me a discount this way. I take the Rx to CVS they fill it and I pay a for only 2 months supply and get the 3rd month supply for free. Saves me money this way. Maybe this is what edwardsfire is talking about?

I should add that the correct dosage is written on the bottle it's just 90 pills instead of 30 or 3 inhalers instead of 1.

That is something totally different. Getting a 3 month supply of a med you take all the time is legal and yes saves the member money.

 

[Nancy]

How is it illegal? Actually, i know it isnt.
How will it "bite him?"
I take one one Generic prilosec per day.
The rx states "take two".
My doc knows im taking one.
This IS done alot.
I get two months for the price of one.
How can this not be understood?

And, one CAN and many DO take 40 mg's (2) prilosecs per day.
PPI's are harmless drugs.

Right and they are getting a script written for the dosage they are taking. YOUR doctor is writing a script with an incorrect dosage, he is in essence lying about the dosage you need so you can put one over on the insurance company. THAT is what is wrong. And it is not done a lot. Maybe done a lot by your doctor but trust me most doctors would not do this.