APhA-ASP Proposal 2005.7 Insurance/ Patient Specific Information

[Caverject]

APhA-ASP supports legislation requiring third-party payors to offer 24-hour access to personnel in order to resolve patient coverage issues, including but not limited to the confirmation of patient benefit status and the authorization of payment for services.

Background Statement:
Patients frequently require pharmacy services outside of normal business hours. While patients have access to pharmacists on a 24-hour basis, pharmacists may not have the same access to third party information to resolve patient coverage issues. As a result, patient safety may be compromised when medications may not be dispensed due to unadjudicated claims. Patient care, convenience and the pharmacist-patient relationship may also be sacrificed when a patient must wait until the next business day to obtain their medication. If third party payors offered access to personnel on a 24-hour basis, situations in which an insured patient must go without or delay medication could be avoided.

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[Caverject]

I think this proposal is plain stupid. If it's something that a patient needs right that second, they can always pay cash and be reimbursed later

 

[rxgal8]

I voted no. I think this is unnecessary. There are other ways around this issue. For example, paying the cash value and getting reimbursed. What's next then....asking all physicians to be availabe 24 hours a day incase a prescription's verification is needed?

 

[Sosumi]

This is pretty stupid. Dealing with insurance is already annoying as it is. Most of the time, the problem can be resolved the next day or later (i.e., prior authorizations usually take a few days at least to work out anyway). Like you all said, if they really need the medicine, they can pay cash. If it's an emergency, the pharmacist often gives a few pills and makes them come back later when the problem can be resolved. This proposal will just give third parties yet another excuse to raise their premiums.