Honestly, it all narrows down to like the same 10 companies.
ESI/PERX (usually requires person code and requires group)
PAID (three digit person code) (requires group)
ANT (no group and usually no person code)
Aetna (no group and usually no person code)
CRK/APM (group and person code required)
PHARM (group required...can't remember person code)
MEDICARE (ID number straight from card...ask them if they have the red, white, and blue card. This is useful for diabetic supplies, however the prescriber must fill out a CMN form and fax it to the Walgreens Medicare office in Illinois and if they change the directions, they have to change the form or else it gets all screwy)
IMMUNMPB (ID from medicare B card. Free flu and pneumonia shot! Does not cover shingles shot, have them contact their Part D plan or primary insurance to see if it covered at a retail pharmacy. Sometimes they'll cover the shot, but only if we dispense it. And we can't dispense Zostavax, it must be administered on site.)
And whatever your state medicaid is.
And whatever other popular ones are in your region. You'll learn quickly enough.
Coupons?
Therapy First=THRFT (group required)
Restat Coupon=RSPCOB or some crap like that, I never remember that one exactly.
Then there's another one that's AEBSCOB or something like that. Group required for both. One of these requires person codes, I can't remember. Check third party inquiry and it will tell you.
Worker's comp is a pain in the rear! Before the patient walks away, make sure you have the date of injury, social security number, current employer, and a contact phone number and address. I don't care what it says in IC+, someone's fat fingers could have punched it in wrong. Write it down for yourself on the back of the script. So if they don't have the ID information, you can call the workers comp (usually First Script or Matrix up in my area) and have the info to find them. Otherwise they give you the whole spiel "sorry, i can't find them in the system blah blah blah".
Best way to figure out if it's any of those? Look at the card. If you see the word express scripts, PERX. If you see CVS caremark...CRK or APM. Oxford and United health are PAID. Occasionally you'll get the oddball plans. Over in this area, some empire plans are processed under PAID while others are under PERX. Honestly, whenever I see BIN 610014 I know it's PAID. But that's pure memorization.
If you forget if you need a group number or not, use the third party inquiry. Plug in the group, or plan name. It will tell you if group required, person code, etc. For Tricare and certain coupons, it will even tell you the group.
If you get a TPR saying to put in an override code...read what it says. If you need to put in 9994 in the PA field for a brand name drug, do it. RxEntry, Options, Third Party, Prior Auth: 9994.
If you get something like ***RxLSA*** when filling lamictal (or a few other drugs), first make sure you typed the script correctly, then go to options, third party, Prior Auth: 6666. Then it will go through. It's basically saying that you're filling the correct drug so this person doesn't die and we don't get sued if for some reason the pharmacist doesn't catch it.
Insurance DUR's are different from actual DUR status in the queue. Insurance DUR's pop up as TPRs. Make sure it isn't an early refill (it will say early refill). If it's a drug interaction, (in my store we print the screen so it's tangible and I can slap the pharmacist in the face with it if they forget I told them about it) create an exception that says drug interaction DUR or something and have the pharmacist review it. Yeah, the interaction will probably pop up again while they F4 the prescription, but god forbid it doesn't and something awful happens. Techs really shouldn't clear DURs unless talking to the pharmacist first and they have the OK to do it (because the pharmcist is just so busy sometimes they can't be bothered to hit M0 1B).
Other basic info you may need to know when people go "WHY IS THIS SO EXPENSIVE?!?!"
-Deductible: They need to pay a certain amount out of pocket before full benefits kick in. The insurance takes off a % stille, about 10-20, but sometimes the patients can be left paying hundreds of dollars. Certain insurance plans tell us if there is a deductible remaining or not, others you are SOL. In the work queue, select the RX, then go to options, view claim info. Usually on the right hand side it will tell you if there is a deductible that needs to be met.
-Non-formulary: Insurance companies have a list of preferred drugs and generics that have cheaper copays. If the drug isn't on that list (Proventil vs Proair....Crestor vs Simvastatin etc), they may be charged a higher rate. Sometimes a penalty fee can apply for getting the non-formulary drug. This fee and penalty often results in an over a hundred dollar copay. Suggest that they don't have to take the drug right now and they can speak to the doctor and insurance company to find a cheaper alternative
Prior Authorization: Insurance won't pay for the drug until the prescriber contacts them and explain why they are using this drug instead of specific other drugs, such as generics. More often than not, people have tried the generics and they didn't work so that's why they're using this one. It just requires someone from the doctor's office to call the insurance and explain why they're using that one. Most of the time, PA's go through. Other times it's not as fun. Honestly once we send the fax to the doctor's office, it is out of our hands. It all depends on how mquickly the doctor contacts the insurance and how quickly it processes in the insurance's system. This can take up to 72 hours if done immediately.
Some insurance plans just suck. Period. I think that's all I can think of for right now...I have a final in about 20 minutes so thanks for keeping me preoccupied! Haha!
I think 610500 is one... never fails, it's always at 5:30 and you have 10 customers lined up by the time you get it done. I think often times it's easier just to call the number on the back of the card...
