EPT walg wisconsin question

[Charcoales]

Advertisement - Members don't see this ad

So... how the heck do you dispense this? Got 1 erx saying to dispense both doses... I probably shouldn't fill the full qty under the one's insurance since technically I'm dispensing for 2 people... maybe bill half under ins and then cash out the other half? Do I print the erx and scan the image under a separate EPT profile? what is that profile even called in IC+?? (I called two walgreens nearby and my home store and they've never done ept before either lol)

 

[beautifulrobot]

Hmm, I actually think you could justify billing the full qty under the one patient's insurance, since in a sense, even though another person (the sexual partner) is receiving treatment as well, EPT is being prescribed as part of the treatment of the one patient, if that makes sense. Looking at Wisconsin law, it appears you don't actually need a separate prescription for each person, just one prescription with the sexual partner's name and address written on the prescription for the patient: Legal Status of EPT - Wisconsin

 

[zelman]

Hmm, I actually think you could justify billing the full qty under the one patient's insurance, since in a sense, even though another person (the sexual partner) is receiving treatment as well, EPT is being prescribed as part of the treatment of the one patient, if that makes sense. Looking at Wisconsin law, it appears you don't actually need a separate prescription for each person, just one prescription with the sexual partner's name and address written on the prescription for the patient: Legal Status of EPT - Wisconsin

Do not bill EPT under the known party's insurance. They are not covered by the policy. They would be like billing a whole family's tamiflu under the one insured person's coverage.

I haven't worked at Walgreens, but I know CVS had a whole set of state-specific instructions on their intranet and EPT was filled under a unique profile each time.

 

[genesis09]

I am in Wisconsin. My understanding is that if there is no name on the ept Rx, you can run it under the original person. However, you cannot bill the insurance. You will need a Rx with the partner's name on it. Some prescribers get around it by giving the person refills or writing for a higher quantity.

 

[beautifulrobot]

Do not bill EPT under the known party's insurance. They are not covered by the policy. They would be like billing a whole family's tamiflu under the one insured person's coverage.

I haven't worked at Walgreens, but I know CVS had a whole set of state-specific instructions on their intranet and EPT was filled under a unique profile each time.

I am in Wisconsin. My understanding is that if there is no name on the ept Rx, you can run it under the original person. However, you cannot bill the insurance. You will need a Rx with the partner's name on it. Some prescribers get around it by giving the person refills or writing for a higher quantity.

It depends on the insurance policy. Some insurance policies explicitly exclude EPT coverage, while others don't.

ETA: and EPT is quite different from Tamiflu treatment for the flu. If your sexual partner doesn't get a course of Tamiflu you will not get re-infected with the flu over and over again. That's pretty obvious, no?

 

[zelman]

ETA: and EPT is quite different from Tamiflu treatment for the flu. If your sexual partner doesn't get a course a Tamiflu you will not get re-infected with the flu over and over again. That's pretty obvious, no?

You're right, since influenza is a self-limiting infection. Change my example to rifampin for TB and point still holds.

 

[beautifulrobot]

You're right, since influenza is a self-limiting infection. Change my example to rifampin for TB and point still holds.

I get what you're saying, and on a very superficial level you're not wrong, but there is quite a world of difference between treating partner exposure to TB and treating partner exposure to gonorrhea and chlamydia, and the analogy doesn't really hold. It makes sense for insurance to cover EPT (for GC) because there is a high likelihood of successful treatment, and it reduces overall costs by eliminating repeat medical exams and repeat treatment. I highly doubt EPT for TB would be nearly as effective as EPT for GC. Management of potential TB exposure, not to mention monitoring needed for rifampin, isoniazid, pyrazinamide, and streptomycin therapy, and the more dire consequences of lack of adherence to an anti-TB regimen, is quite a bit more involved than treating GC. Even EPT for GC isn't ideal, but is just sometimes the best option in certain situations.

EPT is limited to GC because most cases are fairly straight forward and do not usually require extensive follow-up and monitoring, and evidence shows benefits outweigh the risks. You can't make the same case for TB.

 

[zelman]

I get what you're saying, and on a very superficial level you're not wrong, but there is quite a world of difference between treating partner exposure to TB and treating partner exposure to gonorrhea and chlamydia, and the analogy doesn't really hold. It makes sense for insurance to cover EPT (for GC) because there is a high likelihood of successful treatment, and it reduces overall costs by eliminating repeat medical exams and repeat treatment. I highly doubt EPT for TB would be nearly as effective as EPT for GC. Management of potential TB exposure, not to mention monitoring needed for rifampin, isoniazid, pyrazinamide, and streptomycin therapy, and the more dire consequences of lack of adherence to an anti-TB regimen, is quite a bit more involved than treating GC. Even EPT for GC isn't ideal, but is just sometimes the best option in certain situations.

EPT is limited to GC because most cases are fairly straight forward and do not usually require extensive follow-up and monitoring, and evidence shows benefits outweigh the risks. You can't make the same case for TB.

I'm speaking about the billing, not the therapeutics. Just because someone might give you an infection, it doesn't make their treatment the responsibility of your insurer.

 

[beautifulrobot]

I'm speaking about the billing, not the therapeutics. Just because someone might give you an infection, it doesn't make their treatment the responsibility of your insurer.

I understand that's what your saying. What I am saying is that even though EPT involves the treatment of another person, EPT is actually an evidenced-based treatment for the policy holder. EPT is part of the treatment of the policy holder.

 

[beautifulrobot]

Although, again, my understanding is that some insurance policies explicitly exclude coverage for EPT, so it might indeed not be covered, but it's not a guarantee that it's not covered.

 

[owlegrad]

I would be too afraid of charge backs, unless my company policy very explicitly laid out that it was policy to do so.

Just because you logically think the insurance company should cover the partner doesn't mean the insurance company will agree, if they get a chance to claw back some money they probably will.

 

[zelman]

Although, again, my understanding is that some insurance policies explicitly exclude coverage for EPT, so it might indeed not be covered, but it's not a guarantee that it's not covered.

I've spent some time googling, and I am confident that EPT is never covered. I haven't found one state where it must be covered, and plenty where it explicitly isn't. Please try to find one example of an insurance policy that covers medication for a non-covered individual by virtue of their having sex with a covered individual. As it stands, the evidence is overwhelmingly indicating that such a plan does not exist (aside from the incredibly poorly worded statement from New Hampshire).

Abbreviation State Name Covered Source
AL Alabama
AK Alaska
AZ Arizona No http://www.azdhs.gov/documents/prep...ices/std-control/ept-factsheet-physicians.pdf
AR Arkansas No https://nabp.pharmacy/wp-content/uploads/2016/06/AR082012.pdf
CA California Maybe https://archive.cdph.ca.gov/pubsforms/Guidelines/Documents/CA-STD-PDPT-Guidelines.pdf
CO Colorado
CT Connecticut
DE Delaware
FL Florida
GA Georgia
HI Hawaii No http://cca.hawaii.gov/pvl/files/2014/09/131219-min.pdf
ID Idaho
IL Illinois
IN Indiana
IA Iowa No https://idph.iowa.gov/Portals/1/userfiles/105/Iowa EPT Guidelines 2016 update.pdf
KS Kansas
KY Kentucky N/A Legal Status of Expedited Partner Therapy
LA Louisiana
ME Maine No http://www.maine.gov/dhhs/mecdc/infectious-disease/hiv-std/ept/documents/EPT-FAQ.pdf
MD Maryland No https://phpa.health.maryland.gov/OIDPCS/CSTIP/CSTIPDocuments/Maryland EPT Provider Guide_FINAL.pdf
MA Massachusetts
MI Michigan No https://www.med.umich.edu/clinical/images/UMHS-UHS-EPT.pdf
MN Minnesota Maybe Expedited Partner Therapy (EPT) for Chlamydia trachomatis and Neisseria gonorrhoeae: Guidance for Medical Providers in Minnesota - Minnesota Dept. of Health
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire No? https://www.dhhs.nh.gov/dphs/bchs/std/documents/ept-healthcare.pdf
NJ New Jersey
NM New Mexico
NY New York No https://www.health.ny.gov/diseases/communicable/std/ept/docs/faqs_for_pharmacists.pdf
NC North Carolina
ND North Dakota
OH Ohio
OK Oklahoma
OR Oregon No http://www.oregon.gov/oha/PH/DISEAS...DDISEASE/Documents/EPT/EPTProtocolFeb2015.pdf
PA Pennsylvania
RI Rhode Island
SC South Carolina N/A Legal Status of Expedited Partner Therapy
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VA Virginia
WA Washington
WV West Virginia No http://www.dhhr.wv.gov/oeps/std-hiv-hep/resources/Documents/EPT QA for Pharmacists.pdf
WI Wisconsin No https://www.dhs.wisconsin.gov/std/faq-ept-pharmacy-examining-board.pdf
WY Wyoming

 

[beautifulrobot]

@zelman I appreciate you doing your due diligence. I agree that there are, apparently, no laws that mandate either public or private insurance plans cover the patient's sexual partner(s) as part of EPT, although there are policy white papers that support doing so and recommend that insurance plans consider covering EPT. Although I was unable to find an insurance plan that specifically includes coverage for EPT, I also found it extremely difficult to find comprehensive coverage information on the wide variety of insurance plans in this country in general. Many of the documents you referenced in your post state that depending on the insurance plan, it may or may not cover the prescription cost for the partner. I agree there is ambiguity, and that more likely than not insurance will not cover the partner, but it's not completely out of the question. The only way to know for sure (in states in which EPT is legal) is to directly ask a rep of the specific insurance plan of the patient.

 

[BidingMyTime]

I'm probably missing the obvious, but what does EPT stand for?

I gather you are talking about the situations where a doctor rights 2 scripts to treat STD-1 for the actual patient, and 1 for the partner who infected the patient. I've never heard this called EPT before. And yeah, I wouldn't bill both RX's to 1 person's insurance, that definitely sounds like a chargeback.

 

[beautifulrobot]

I'm probably missing the obvious, but what does EPT stand for?

I gather you are talking about the situations where a doctor rights 2 scripts to treat STD-1 for the actual patient, and 1 for the partner who infected the patient. I've never heard this called EPT before. And yeah, I wouldn't bill both RX's to 1 person's insurance, that definitely sounds like a chargeback.

Expedited Partner Therapy

 

[zelman]

I'm probably missing the obvious, but what does EPT stand for?

Seriously? My last post had 17 links to info about it.

 

[BidingMyTime]

Seriously? My last post had 17 links to info about it.

Now that you point that out, I did miss the obvious! I just looked at IL, and IL didn't have a link, and since that is the only state I'm currently interested in, so I didn't pay attention to the other states.