- Joined
- Dec 12, 2012
- Messages
- 247
- Reaction score
- 28
As a newly registered pharmacist, today was one of my saddest experience but of course a learning opportunity.
This patient with the diagnosis of syphilis walked in (who btw had a reputation to be super annoying as he believes since he has insurance every medication in the world should be covered) and wanted to speak with the Rph about his Bicillin not getting covered. After begrudgingly calling the insurance company on his behalf with him standing beside me and after failing to explain to him that he has to wait until the PA goes thru, he was frustrated and looked visibly sad.
The insurance rep. did try her best to determine the coverage eligibility by asking if the medication could be self administered..that might be a reason why the MD may need to address in the PA and hence needs to be adjudicated by the insurance. At the end of the day, much to the patients desperation and frustration, I could convince him about the waiting for the PA to go through..but it raised few questions which I wish I knew the answer of.
1. Most IM and SC injectables can be self administered after one or two office visits when the MD determines patient can take it themselves going forward. How do the insurance companies determine which one is self injectable and which one is NOT since it depends entirely upon the MD and the patient.
2. Is there a comprehensive list of injectables which are commonly self administered?
3. What if we could administered some of these (besides vaccines) and if we did so, could we bill them ? ( I recently received this Silverscript bulletin where caremark reimburses pharmacists for vaccine ADMINISTRATION).
This patient with the diagnosis of syphilis walked in (who btw had a reputation to be super annoying as he believes since he has insurance every medication in the world should be covered) and wanted to speak with the Rph about his Bicillin not getting covered. After begrudgingly calling the insurance company on his behalf with him standing beside me and after failing to explain to him that he has to wait until the PA goes thru, he was frustrated and looked visibly sad.
The insurance rep. did try her best to determine the coverage eligibility by asking if the medication could be self administered..that might be a reason why the MD may need to address in the PA and hence needs to be adjudicated by the insurance. At the end of the day, much to the patients desperation and frustration, I could convince him about the waiting for the PA to go through..but it raised few questions which I wish I knew the answer of.
1. Most IM and SC injectables can be self administered after one or two office visits when the MD determines patient can take it themselves going forward. How do the insurance companies determine which one is self injectable and which one is NOT since it depends entirely upon the MD and the patient.
2. Is there a comprehensive list of injectables which are commonly self administered?
3. What if we could administered some of these (besides vaccines) and if we did so, could we bill them ? ( I recently received this Silverscript bulletin where caremark reimburses pharmacists for vaccine ADMINISTRATION).
