I recently had a conversation with somebody who had "wasted" an entire day trying to sort out an issue with a new prescription.
The pharmacy called her and informed her that the new drug wasn't covered by her Medicare policy (which she had just started getting) and the co-pay was a bit stiff. They wanted to know if they should fill it or if she wanted to consult with her doctor.
"Well, how much IS the co-pay" our hero asked.
"$1100 a month" they informed her.
"Yay, you don't need to fill that prescription. I gotta talk to my doctor..."
Then she played phone-tag trying to drill-through the layer of people who protect actual doctors.
The doctor's office gave her a list of other medications that would treat her issue.
The issue escalated to the point where our hero was not communicating with the local drugstore but with somebody at the hub. The person at the hub determined that the order the branch was trying to fill was not the one that had been sent from the doctor's office nor did it match the one on-file at the drugstore's central server.
The drug prescribed was covered by her Medicare. The drug listed in the computer at the local branch bore absolutely no resemblance to either the prescribed drug or its generic equivalent.
Four scenarios
1. Some dufus accidentally deleted the order and guessed when they attempted to manually recreate the computer record. This assumes that an order can actually be manually created at the retail pharmacy level.
2. Noise in the communication bus and the parity checks did not catch the discrepancy.
3. A malicious computer nerd wrote some code to randomly change an imperceptibly small fraction of the prescriptions. He could kill patients with certain profiles by the score every month and nobody would ever think to look for him if the pharmacy chain was large enough.
4. The seemingly random noise in prescriptions is authorized at a higher level to weed out high-cost medical obligations.
5. ---Added--- My friend misunderstood what she was told over the phone.
Heck...I should write fiction!
Had the same issue.
ReplyDeletemed ee care is ass.
"Insurance" very restrictive.
Doctor networks crooked as can be.
Get and stay healthy!
Item 5: your correspondent's med was not on his flavor of medicare's "formulary of the month".
ReplyDeleteWhich, of course, is NOT shared with the prescriber.
Which is why you take along the formulary printout to your doctor on every visit. Doctors know, and they are quite good, generally, about prescribing meds that hit a manageable co-pay level.
DeleteIf your drugs change in their co-pay, or will no longer be available, the Part D plan is required to notify you ASAP. The trouble is, the notice is often ignored in that mess of mail that is created. If the doctor knows, he can either prescribe a substitute that is on the list, or put in a formal request for an "exception", which allows you to get the disallowed drug for a lower price.
"The drug listed in the computer at the local branch bore absolutely no resemblance to either the prescribed drug or its generic equivalent."
ReplyDeleteSo who gets sued when the patient dies????
Who even looks at the meds an older patient is taking at the time of death to verify their appropriateness for their illness at death?
DeleteGood question
DeleteCome to the UK. Doctor gives you prescription, take to any chemist (Pharmacy), get medication. Job done.
ReplyDeleteKnowing several developers from "Epic Systems" and related firms, most likely scenario is the person who input the doctor's prescription into the system typo'd the order (could be the doctor, or more likely their staff) and didn't notice the discrepancy.
ReplyDeleteDoctors still have chicken-scratch handwriting, poor keyboard skills, and an ego which keeps their staff from asking them to confirm what they wrote/typed.
The way the story was told to me is that the correct prescription was on the drugstore's server at HQ but an incorrect prescription at the retail branch.
DeleteThe correct prescription was covered and had a $30 co-pay.
ERJ, this is not as ridiculous as it seems. My aunt had an incident just recently where the M.D. prescribed a medication that she was allergic too and it was not caught at the doctor's office but by the pharmacist.
ReplyDeleteWhile Pharmacists are usually well educated and intelligent not so with the staff who actually do much of the paperwork. I know his firsthand. My ex wife spent much of her life working in a pharmacy as a clerk/tech. She is a high functioning moron. One of the reasons she's my ex. God only knows how many medication errors occurred due to her. As a customer you should be checking the meds you recieve closely against the order written by the prescriber.
ReplyDeleteOHHHHHHHHHHHHH !!!
DeleteThe stories I could tell about bad pharmacists !!!!