Thursday, July 28, 2016


Some people think the Pharmacist has ULTIMATE POWER.

Consider if you will the story of Mrs. Advent, one week away from needing her Advair and Ventolin inhalers. Now I suppose you can't fault her for wanting them filled today, except for the fact she's already on Automatic Refill and we always have it ready for her in advance.

No, she wants them right now.

Flynn the tech sends a claim. "Coverage Terminated as of 12/31/2014." He tells Mrs. Advent the results.

"No. It's not terminated."

Aladdin rubs his magic lamp again. No Genie. He tells her she must have a new card or a new ID number.

"No. It's the same number and still active. May I please see the pharmacist?"

He comes to get me. I was actually doing something important but Mrs. Advent needs to speak to me, immediately. By all means, let's distract the pharmacist while he's dealing with medications that save people's lives.

I step up to the window. Mrs. Advent starts by telling me about her asthma condition and that she can't be without her medication.

Let's see, I've been filling for you for YEARS and you think I didn't know you have asthma? Really?

Then she tells me that the technician doesn't know what he's doing because her insurance information hasn't changed. She's sure that if I step up to the computer and process the claim, I will be able to use my almighty power over the heavens and earth to get it through. 

I'm up to the challenge. I send off the claim...

"Coverage Terminated as of 12/31/2014."

Now of course I have to tell her all the same stuff Flynn already told her about her insurance. I even told her we'd be happy to call and confirm that information... AFTER we're caught up on the current SNAFU at present in the pharmacy.

Mrs. Advent gets upset and once again tells me she can't be without her medication... 

Thanks for that, I completely forgot what you told me like three minutes ago. a week or so, because she's really not out yet. We're pre-emergency right now, and that's almost like an emergency when you're asthmatic.

I assure her that no matter what happens we won't let her go without her medication. I tell her to go home and relax then call her insurance and find out her new information. She agrees that she'll call the insurance, but only to find out why it's not working today or what we've done at the pharmacy to keep it from working.

The next day...

In walks Mrs. Advent. She called the insurance which told her about the change that was made and that they sent out new cards. Fortunately she didn't throw away the envelopes and has the info for Flynn to process.

He puts in the new info... sends off a claim...

"Claim Denied. Prior Authorization Required. Step Therapy Required."

Flynn tells her the bad news, but because she's been on the medication for a long time her doctor will be able to call her new insurance and straighten it out, no problem.

And of course... she's NOT satisfied... and she asks...

"May I please see the pharmacist?"

Euthanize Me!


Anonymous said...

I lay the blame thick and heavy when a prior authorization comes up. "YOUR insurance is REFUSING to pay for YOUR medicine. YOUR doctor might be able to convince THEM to pay. I'll send over the info THEY need right now. Be sure and call YOUR insurance as soon as possible to see why they're doing this."

Anonymous said...

Sometimes you wish you could jump through the phone line and strangle someone or something.