Fertility Billing

[Pharmer241]

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Hi,

My pharmacy is starting to develop some fertility services, and we are putting together the potential workflow. We have spoken to a few people as to how to bill and maintain anonymity.

One nurse said one pharmacy would bill both the donor and receipients medications under the recipient's insurance (this sounds illegal), others have said the donors may not use their name but be assigned a number, but I would think from a legality standpoint the prescription would still have to have their name on it.

Can anyone shed any light on any intricities that may be required for billing fertility medications?

 

[Digsbe]

By fertility medications are you talking about sperm/egg donations or medications to enhance fertility or treat infertility? I would imagine billing for the drugs themselves would be similar or identical to billing for any other prescription drug. I could be wrong though.

 

[Pharmer241]

I mean drugs like Bravelle and Follistim. I think for the most part they are the same, but I wasn't sure if any issues arise in terms of remaining anonymous and arranging payment for the donor side if they are getting medications.

 

[spacecowgirl]

bill the fertility clinic

 

[Pharmer241]

Bill the fertility clinic for the donor's drugs, and have the recipient pay them, and then the clinic pays us?

 

[Ackj]

bill the fertility clinic

I'm not sure how you'd go about doing it through pharmacy software, but could you set up XYZ Clinic as a patient, and bill the drugs to it for cash, as if it were an RX? Would you have to register as a wholesaler to do that?

 

[Pharmer241]

Thats what I'm trying to figure out. I had a nurse tell me that the "donor" medication would be billed through the intended parent's prescription coverage. I spoke to someone at a third party company and they said that was illegal. I feel like the patient (whoever they may be) would have to have their name on the prescription somewhere, or at least in our pharmacy software system.

 

[ccpanswerer]

Thats what I'm trying to figure out. I had a nurse tell me that the "donor" medication would be billed through the intended parent's prescription coverage. I spoke to someone at a third party company and they said that was illegal. I feel like the patient (whoever they may be) would have to have their name on the prescription somewhere, or at least in our pharmacy software system.

I agree. How could you/why would you fill an rx for a literal Jane Doe with no information about said patient? Wouldn't that violate pretty much all tenets of pharmacy practice? How would you be able to make sure there are no drug interactions? Pharmacy records are protected via HIPAA anyways so I don't know why the issue of privacy is going to come up. Talk to a pharmacist who has done this before because nurses are experts on nursing, not pharmacy.

 

[zelman]

I agree. How could you/why would you fill an rx for a literal Jane Doe with no information about said patient? Wouldn't that violate pretty much all tenets of pharmacy practice? How would you be able to make sure there are no drug interactions? Pharmacy records are protected via HIPAA anyways so I don't know why the issue of privacy is going to come up.

There are specific state laws that allow pharmacists to fill prescriptions for sexual partners of patients with STIs without knowing who they are. It's a rare situation in pharmacy, but anonymity can happen.

However, all the times I have filled these prescriptions, they were not purchased since I couldn't bill insurance and the full price was unacceptable to the partner.

 

[ccpanswerer]

There are specific state laws that allow pharmacists to fill prescriptions for sexual partners of patients with STIs without knowing who they are. It's a rare situation in pharmacy, but anonymity can happen.

However, all the times I have filled these prescriptions, they were not purchased since I couldn't bill insurance and the full price was unacceptable to the partner.

Apples and oranges. That is because part of treating and STI is treating the partner. This is not done to ensure privacy of any of the partnets. You still wouldn't be able to bill the original partner for the second's meds. This other situation falls out of this one particular legal exception. Anyways, HIPAA applies to the fertility clinic so I don't know why privacy is a concern.