So, I basically disappeared for a couple of years. Is that even possible? Apparently it is...because I actually did it. And, in those years, I was (and still am) plugging along in the pharmacy. There were some major hurdles in that time. I'm pretty sure we've all been trying to jump one common hurdle for the past year or so. C19, and it's effect on our lives, at work and home. I'm winning so far. I hope you are winning, too.
Let's just pretend we caught up over a cup of coffee (or a bottle of wine) and pick up where we left off, because I do have an interesting, or maybe not so interesting, story to share.
Picture it. Pharmacy. (read Golden Girls Sophia style).
You've come to pick up your prescription. Brand name. You get it filled for 90 days at a time, and have been taking it for years. YOUR prescription insurance has always covered it. Until today. Today is the day we get to tell you that something has changed with YOUR prescription insurance formulary since the last time you filled your prescription (which, in this case, was the previous year), and the brand medication is no longer on the formulary (drugs they will cover). I bet you can already feel the tension...
Let me back up and tell you something about your prescription insurance and it's formulary. I Don't Really Know The Details of YOUR Insurance and prescription drug coverage! I know you think I do, but I don't. I know most of the details of my insurance through my employer, but I DON'T know yours. At the pharmacy, we submit your prescription information electronically to your insurance. Then, YOUR insurance tells us what's going to happen. There are many, many responses we might receive. The best is always one with a small (or zero) copay. Unfortunately, that's not the one we get each time. The bottom line...YOUR insurance calls the shots. They are the boss.
We now return to our regularly scheduled interesting interaction.
While looking at the reject response on the screen, I tell you (it wasn't really me in this story) your insurance has rejected the claim, stating the brand drug is no longer on the formulary (product/service not covered on formulary/closed form). You're not having any of it. You huff at me that you always have this problem when you come to our pharmacy. You insist the drug is covered and we always make this mistake. I inform you that I can see that the drug has been covered in the past, even pointing out the last time you picked it up.....and mentioning that was in 2020, last year, and things often change with prescription insurance coverage from year to year. You tell me NOTHING has changed. I have made a mistake and need to redo my work. So, just to be on the safe side (why do I doubt myself) I take a little walk over to the Help Pharmacist. She takes a look at your profile and tells me exactly what I've already told you.
On my return to your transaction, I think of the best way to tell you that you'll need to do some research because something HAS changed and you weren't aware of it until this moment. What I come to realize is....there is no BEST way. You're still not having any of it. So, you huff at me a little more (while I apologize for your dissatisfaction with my "lack of" professionalism) and you depart with a huff and a promise to show me the error of my ways.
Later that day, our fax machine spits out a new prescription for your medication from your doctor....generic...all "yeah, you were right, but I'm not going to tell you to your face style". Hey, it happens. It would be difficult for the average person to know all the changes that occur with their prescription drug plan year to year (or even month to month as generics come on the market). The best way to find out what's up with your prescription insurance is from your prescription insurance customer representatives. I don't expect you to know, but I would greatly appreciate it if you didn't automatically assume we screwed it up because we are not professionals. We are always striving to get you the proper medication at the best price in the most timely fashion. Whether you're having it or not.
Don't forget to take your happy pill!
