Discount cards

[aaronstnt]

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Can we use the PHI we have in the pharmacy to sign patients up for discount cards on their behalf? What ethical issues would we run into? Unfair business practices? Charge backs? Thanks for any suggestions.

 

[Ackj]

Can we use the PHI we have in the pharmacy to sign patients up for discount cards on their behalf? What ethical issues would we run into? Unfair business practices? Charge backs? Thanks for any suggestions.

I'm not sure about the ones you need to sign up for, but I remember a while back a drug rep actually dropped off some cards for us to use on patients. Pretty sure it was something that was going generic, but I could be mistaken. It was a while ago.

 

[hydromorphone]

Some community pharmacies have policies against accepting discount cards delivered by drug representatives. Regardless, you should ask the patient if you can bill their prescriptions to pre-activated discount cards. Enrolling patients into discount programs without their knowledge is a breach of privacy.

 

[aaronstnt]

Why not invest in these drug companies and just start pushing all the products that have discount cards? Work once and get paid twice. Would this violate any Fed. laws?

 

[All4MyDaughter]

We don't accept those "discount" cards. A lot of them rip the pharmacy off. So says our PIC/owner.

 

[Ackj]

We don't accept those "discount" cards. A lot of them rip the pharmacy off. So says our PIC/owner.

I think you're thinking of the cards that are basically insurance for the uninsured, where they take off some percentage from AWP. Those cards can crush the pharmacy, since you pretty much get no 3rd party income, and the copay is sometimes lower than acquisition cost.

The cards I am talking about are directly from the manufacturer. Usually need to have a primary insurance to bill, but it cuts the copay down. Common one we see is for Lipitor, normal copay is say $20-50, but after this card it's $4. You split bill it, so you get reimbursed by primary insurance, manufacturer, and the tiny copay. Would I rather get the money immediately, rather than wait to be reimbursed? Sure, that'd definitely be better for the business, but the patient is probably more likely to get refills on something "affordable" than something they dread paying.

 

[Dr Wario]

Those manufacturer discount programs also often have processing fees that go to the pharmacy associated with them ($1-$2 avg) so they are actually pretty good for the pharmacy. Though they are still a PITA.

 

[All4MyDaughter]

I think you're thinking of the cards that are basically insurance for the uninsured, where they take off some percentage from AWP. Those cards can crush the pharmacy, since you pretty much get no 3rd party income, and the copay is sometimes lower than acquisition cost.

The cards I am talking about are directly from the manufacturer. Usually need to have a primary insurance to bill, but it cuts the copay down. Common one we see is for Lipitor, normal copay is say $20-50, but after this card it's $4. You split bill it, so you get reimbursed by primary insurance, manufacturer, and the tiny copay. Would I rather get the money immediately, rather than wait to be reimbursed? Sure, that'd definitely be better for the business, but the patient is probably more likely to get refills on something "affordable" than something they dread paying.

Oh yeah. I had one of those for an expensive derm thing I needed a few months ago. I haven't seen any of those at my current community pharm job. Makes me wonder if we don't accept them either?

 

[DASicari]

For the drug manufacturer's coupons, often times the patient has to call and activate the card before it can be used for processing, thereby the patient will give all of the info requested.

I haven't run into a situation where the pharmacy would give out PHI for these coupons to work.

 

[Ackj]

For the drug manufacturer's coupons, often times the patient has to call and activate the card before it can be used for processing, thereby the patient will give all of the info requested.

I haven't run into a situation where the pharmacy would give out PHI for these coupons to work.

Now that I think about it, isn't sending the claim itself PHI? I mean, it has their name and the name of a prescription they're taking.