Yesterday my wife was kind enough to go to Target with a prescription of mine.
She was informed that there was a problem - since the last time my monthly prescription was filled, my insurance had adopted a new policy that prohibited allowing the medicine (a stimulant) to be dispensed to anyone over the age of 19. She informed the pharmacist that I had been taking the medicine for the past 3 years - a doctor specifically prescribed it to counteract the sedative effects of blood pressure medication....
My wife patiently waited while the pharmacy contacted my insurance company. She was informed that I would need a special note from my doctor and then they would decide whether payment would be made.
My wife indicated that I was out of the last prescription because an earlier rule put into place prevents prescriptions for all types of medication from being refilled until there is only one or two days before the pills from the last prescription run out. She also noted that another rule prevents the doctor from directly calling in the prescription, for this medicine, or prescribing more than 30 days of the medicine at a time.
Instead of the doctor being able to address this issue promptly - I take time to pick up a prescription that will not be filled, my wife takes time to bring the prescription that will not be filled to Target, Target takes time to contact my doctor who will have to take time to complete and send paperwork, which may or may not persuade my insurance (rhymes with true) to dispense the medication that my doctor prescribed and I am without.
In retrospect:
1). A doctor is unable to call and/or fax in a prescription - the prescription has to be picked up by the patient.
2). The prescription can not be refilled until only one or two days before the medicine from the prior prescription has run out.
3). The prescription cannot be for more ...than 30 days worth of medicine (as opposed to a 90 days worth).
But - that's not all:
4.) A doctor has to provide the insurance with a special request for authorization once every year, even if the condition being treated is chronic and would inherently require lifetime continuation of treatment.
5.) The doctor has to provide the insurance with a new authorization request any time that there is a dosage change, such as from 10 to 20mg, in the medicine the person is taking.
6.) The insurance company may or may not honor the request of your physician.
Some people actually believe that The Affordable Health Care Act (Obamacare), still months away from activation, will ruin medicine - REALLY!
Once again Puck strikes - "What Fools these Mortals Be."
