PReferred pharmacy

[ZakMeister]

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new pharmacist here..

So today a patient calls and tells me that her insurance sent her a letter saying not to fill with us (apparently the name of our pharmacy was on the letter) otherwise she will have copays. Are insurance companies supposed to go about it this brazenly? Have you guys come across sth similar ?

 

[Rouelle]

Are you at a chain or an indy? I would be shocked if the insurance specifically named an independent. If an insurance named a chain, it seems distasteful but not really unexpected.

 

[ZakMeister]

Are you at a chain or an indy? I would be shocked if the insurance specifically named an independent. If an insurance named a chain, it seems distasteful but not really unexpected.

Indy. Either way, isn’t it against the law to tell a patient soecifically where to go or not to go ?

 

[Rouelle]

I suppose they can state the fact that you are a non-preferred pharmacy and will have higher co-pays than a preferred one. I see nothing illegal with that. They are not forbidding her to go to you; they’re just not going to pay for it. True, I tend to view many PBM tactics to be shady and distasteful but it’s just the way the business works.

 

[OXYFORALL]

Best part is they direct patients elsewhere with the preferred bs and when we run the claim we get the same copays most of the time. They save zero dollars going to the "preferred pharmacy" which is almost always CVS.

 

[HandsomeVampire]

Another reason that I get yelled and blamed at, for being a preferred pharmacy.

 

[imcallingcorp]

Indy. Either way, isn’t it against the law to tell a patient soecifically where to go or not to go ?

mostly every medicare plan this year has preferred pharmacies. these pharmacies in exchange for their status take terrible reimbursement. medicare has to allow patients access to non preferred pharmacies also however patients will have higher copays. so the plan will most definately notify their patients to use their preferred pharmacies thats how the mob works

 

[BigBoss]

Insurance companies do this not only with pharmacies, but also with specific physicians. Not illegal though. The wording in the letter wouldn't say not to utilize a specific medical service, but rather they will not cover a service or pay less for it as to discourage use of that service.

 

[ranger99rx]

Also, your pharmacy may lose preferred status due to your medicare D patients non-adherence to their maintenance drugs (diabetic, cholesterol, blood pressure) or your star rating is low.