CVS Techs/Intern/Pharmacists Help!

[sakket]

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Hey guys!

For Rxnet, I recently encountered a reject from a claim for a product not being covered by Medicare part D. I was wondering if a prior authorization will allow the product to be covered? I called HealthNet and they said the product would not be covered.

Thank you!

 

[Old Timer]

When you call the plan, ask for an alternative. Call the doctor and let him know and call the patient to keep them up to date on the situation.

 

[BidingMyTime]

Hey guys!

For Rxnet, I recently encountered a reject from a claim for a product not being covered by Medicare part D. I was wondering if a prior authorization will allow the product to be covered? I called HealthNet and they said the product would not be covered.

Thank you!

There are classes of drugs which are excluded by law for Medicare part D coverage (benzos, vitamins, OTC's, etc.) There is nothing a doctor can do to get these drugs covered, because the law forbids it. The patient will have to pay cash, or do without (they can probably find a discount card on-line to get the drug cheaper, but most of the drugs in the non-covered classes don't cost that much anyway.)