Guest guest Posted December 14, 2004 Report Share Posted December 14, 2004 Hi all- Rant #156 Does anybody here work for NMHC Mail? A post from a mail order tech just may help give me a much needed attitude adjustment. It would put a face on this colossal mail order entity I have to contend with. Recently, our health insurance administrator (Zenith) decided to enforce mail order through this company for maint. meds--or pay out of pocket at the pharmacy of my choice. The whole idea just hacks me off to no end!!! I don't mind an increase in copays. What I do mind is the increase in copays AND restrictions on where I get refills. No offense Florida, but I would prefer my scripts be filled in the state that I live in---you know support my local economy--not Florida's. I don't take any meds, but my husband does... I briefly thought about putting the old boy out to pasture, but thought I would try posting here first. Thanks for your time, Dora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2004 Report Share Posted December 17, 2004 Dear Dora, I do not know enough about this to comment. But I think this is illegal unless you have an hmo that is connected to its own clinic or pharmacy. And example would be Kaiser or the old Maxi Care or Ross Loos. Am I wrong?? I do hope this works out for you. I know you well and I can see the steam coming out of your ears! Love ya Jeanetta > > Hi all- > Rant #156 > Does anybody here work for NMHC Mail? A post from a mail order tech > just may help give me a much needed attitude adjustment. It would put > a face on this colossal mail order entity I have to contend with. > > Recently, our health insurance administrator (Zenith) decided to > enforce mail order through this company for maint. meds--or pay out > of pocket at the pharmacy of my choice. > The whole idea just hacks me off to no end!!! I don't mind an > increase in copays. What I do mind is the increase in copays AND > restrictions on where I get refills. No offense Florida, but I would > prefer my scripts be filled in the state that I live in---you know > support my local economy--not Florida's. > I don't take any meds, but my husband does... I briefly thought about > putting the old boy out to pasture, but thought I would try posting > here first. > > Thanks for your time, > Dora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 17, 2004 Report Share Posted December 17, 2004 Hi Jeanetta and Dora, Not only is this not illegal - it is becoming the trend in keeping costs down for the insurer. Most companies choose the option which allows up to 3 fills a year at a retail pharmacy for maintainence meds then the patient must use mail order. ***Side note to all - read your policy regarding this option. Most patients don't read the fine print and end up at my step with a drug not covered rejection for fill #4.*** Anyway, another cost cutting option is allowing patients to get a 90 day supply of a maintainence med through mail order with a zero copay or a lesser copay than the customer would be charged if they had the same drug filled at the retail level for a 30 day supply. Sounds confusing that way, so let me show an example. A patient can get a 90 day supply of Wellbutrin XL from mail order for a $5.00 copay or the patient can choose to get the rx filled at retail for a 30 day supply for a $10.00 copay. The mail order option is ALWAYS cheaper. Which sounds good to a patient trying to save a few bucks. But what happens is by cutting out the retail pharmacist the patient doesn't get the counseling needed. It's almost impossible to call a mail order facility and speak with someone directly. The patients (often elderly and confused) end up at a retail pharmacy anyway with lots of questions and unidentified pills (because the mail order used a different generic than we did) and not that we mind per se but our pharmacists end up doing the un-reimbursed counseling anyway. Dora, you are not alone in this - the whole retail industry has been trying without much success to fight this option. Good luck, -- To love what you do and feel that it matters - how could anything be more fun? -- Graham .. . . for my heart rejoiced in all my labour . . . Ecclesiastes 2:10 -------------- Original message -------------- Dear Dora, I do not know enough about this to comment. But I think this is illegal unless you have an hmo that is connected to its own clinic or pharmacy. And example would be Kaiser or the old Maxi Care or Ross Loos. Am I wrong?? I do hope this works out for you. I know you well and I can see the steam coming out of your ears! Love ya Jeanetta > > Hi all- > Rant #156 > Does anybody here work for NMHC Mail? A post from a mail order tech > just may help give me a much needed attitude adjustment. It would put > a face on this colossal mail order entity I have to contend with. > > Recently, our health insurance administrator (Zenith) decided to > enforce mail order through this company for maint. meds--or pay out > of pocket at the pharmacy of my choice. > The whole idea just hacks me off to no end!!! I don't mind an > increase in copays. What I do mind is the increase in copays AND > restrictions on where I get refills. No offense Florida, but I would > prefer my scripts be filled in the state that I live in---you know > support my local economy--not Florida's. > I don't take any meds, but my husband does... I briefly thought about > putting the old boy out to pasture, but thought I would try posting > here first. > > Thanks for your time, > Dora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 18, 2004 Report Share Posted December 18, 2004 Dear , Thank you for the explanation and example. Very well presented, I may add. I can see this from the stand point of saving money for the patient. But it also adds to the confusion. I think all mail order must require that the drug be originally filled with inperson counseling from a retail pharmacy first, then it could be transfered. That of course will never be the law and it would only cut down on 'some or part' of the problem. But it would help a bit. Also I think retail pharmacies should also be allowed to offer a maintenece drug for a 3 month / 90 day supply for the min co-pay. Of course this should only be allowed to be considered a maintence drug if the patient's doctor does not need to see the pt for another 3 months or so. Any doctor that orders a maintence drug to a new patient who is put on this drug fro the first time should indicate only for a specific number of days because it is a new drug or first time Rx for this specific pt. That again is a type of drug that I believe should not be filled via mail order. But again these safe guard ideas will not be implemented because the mail order and the insurance companies will loose money. Thanks Jeanetta cphtgenius@... wrote: Hi Jeanetta and Dora, Not only is this not illegal - it is becoming the trend in keeping costs down for the insurer. Most companies choose the option which allows up to 3 fills a year at a retail pharmacy for maintainence meds then the patient must use mail order. ***Side note to all - read your policy regarding this option. Most patients don't read the fine print and end up at my step with a drug not covered rejection for fill #4.*** Anyway, another cost cutting option is allowing patients to get a 90 day supply of a maintainence med through mail order with a zero copay or a lesser copay than the customer would be charged if they had the same drug filled at the retail level for a 30 day supply. Sounds confusing that way, so let me show an example. A patient can get a 90 day supply of Wellbutrin XL from mail order for a $5.00 copay or the patient can choose to get the rx filled at retail for a 30 day supply for a $10.00 copay. The mail order option is ALWAYS cheaper. Which sounds good to a patient trying to save a few bucks. But what happens is by cutting out the retail pharmacist the patient doesn't get the counseling needed. It's almost impossible to call a mail order facility and speak with someone directly. The patients (often elderly and confused) end up at a retail pharmacy anyway with lots of questions and unidentified pills (because the mail order used a different generic than we did) and not that we mind per se but our pharmacists end up doing the un-reimbursed counseling anyway. Dora, you are not alone in this - the whole retail industry has been trying without much success to fight this option. Good luck, Quote Link to comment Share on other sites More sharing options...
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